(40) Implementation of an outpatient best practice advisory to increase allergy referrals for penicillin delabeling evaluation

Background: Approximately 10% of the population reports a penicillin allergy, while studies demonstrate that 90% of these patients can tolerate penicillin-class antibiotics. The presence of a mislabeled penicillin class allergy has been shown to lead to worse healthcare outcomes and increased costs. Evidence suggests that the implementation of penicillin delabeling best practice advisories (BPA) has the potential to significantly increase the identification and delabeling of patients with penicillin-class allergy.

Objectives: Given the lack of a standardized protocol to identify and refer patients with a penicillin allergy label at UW Health General Pediatrics Adolescent Medicine (GPAM) clinics, we developed and implemented the following SMART aim: Increase the rate of referrals for penicillin delabeling at the Union Corners GPAM clinic site from 10% to 30% of patients with penicillin allergy labels by implementing a penicillin delabeling clinical decision algorithm and BPA over a 12-month period.

Design/Methods: We initially assessed the baseline rate of penicillin delabeling referrals at the Union Corners GPAM clinic. We then sought feedback from GPAM and allergy and immunology stakeholders regarding strategies to increase referrals for penicillin delabeling evaluations. Based on stakeholder feedback, we designed and implemented a penicillin allergy clinical decision aide, which we shared with GPAM providers at their monthly staff meeting. We subsequently implemented a BPA at the Union Corners GPAM clinic. Through multiple PDSA cycles, we have implemented and optimized the BPA and provider education to improve the penicillin delabeling rate at Union Corners GPAM clinic, which we have tracked utilizing a run chart.

Results: Prior to our intervention, the baseline rate of referrals for penicillin delabeling at the Union Corners GPAM clinic was 10%. Following presentations at Union Corners regarding penicillin delabeling and initial implementation of a penicillin delabeling BPA, the median rate of penicillin delabeling referrals increased from 10% to 70%. (Figure 1)

Conclusion: These results demonstrate that both increased education regarding the importance of penicillin delabeling and implementation of a penicillin delabeling BPA have the potential to markedly improve the outpatient referral rate for penicillin delabeling. In terms of next steps, we plan to continue to optimize our BPA and provider educational materials and to implement this BPA at additional GPAM clinical sites in the near future.