SHM Converge Scientific Abstract ePoster Gallery-Hospitalist-Driven Penicillin Allergy Delabeling at a Tertiary Care Academic Medical Center

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A hospitalist-driven penicillin allergy delabeling pathway was implemented at the University of Colorado Hospital to improve antimicrobial stewardship and increase inpatient delabeling rates. Penicillin allergy labels are common, often inaccurate, and frequently persist despite the fact that many patients lose IgE-mediated sensitivity over time.<br /><br />Before the intervention, only about 10 hospitalized medicine patients per year were delabeled at UCH, representing roughly 0.1% of encounters with a penicillin allergy label. The project aimed to increase this to 100 patients, or 5%, over one year.<br /><br />The pathway, launched February 28, 2024, was embedded in the electronic health record and designed for internal medicine clinicians. It included orders, quick links, and educational resources. Eligible patients were adults admitted to general medicine with a PEN-FAST score of 3 or less. Several exclusion criteria were used, including critical illness, pregnancy, daily steroid use, current antihistamine therapy, and inability to provide an allergy history. Clinician education and twice-weekly EHR notifications from a medical student and Allergy/Immunology fellow supported implementation.<br /><br />Results showed that 128 patients were delabeled in the first year, surpassing the project goal. Fifty-three patients (41%) subsequently received appropriate penicillin antibiotic therapy. There were no documented adverse reactions from direct oral challenge or from switching to penicillin antibiotics. Seven patients were inappropriately delabeled, but they were relabeled and referred for Allergy/Immunology follow-up.<br /><br />Overall, the project demonstrated that a hospitalist-led inpatient penicillin allergy delabeling pathway can be safe, efficient, and effective, while expanding access to appropriate antibiotics and improving stewardship.

Asset Subtitle

Anita N. Moudgal

Meta Tag

Author List Anita N. Moudgal, Anjeli Kalra, Eric Grimm, Lakshmi G. Nair, Misha Huang, Neal Chandani, Tara K. Ward

Category Research

Concept Penicillin Allergy

Concept Direct Oral Challenge

Concept Delabeling

Concept PEN-FAST Score

Concept Mislabeling

Distinguished Finalist

Presenter Organization University of Colorado School of Medicine

Presenting Author Anita N. Moudgal

Track Quality Improvement

Keywords

penicillin allergy delabeling

hospitalist-led pathway

antimicrobial stewardship

inpatient delabeling

University of Colorado Hospital

PEN-FAST score

electronic health record

direct oral challenge

allergy label removal

internal medicine clinicians

Penicillin Allergy

Direct Oral Challenge

Delabeling

PEN-FAST Score

Mislabeling