SHM Converge Scientific Abstract ePoster Gallery-Not So Fast: Using an Innovative Rounding Model to Standardize Use of Pen-Fast Score for Inpatient Penicillin Allergy De-Labeling

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This quality improvement project implemented a standardized inpatient workflow to de-label inaccurate penicillin allergies using the PEN-FAST score on two medical units at Riverside Methodist Hospital.<br /><br />The process began with identifying patients who had a listed penicillin allergy, providing education materials, and placing a visual reminder on the patient’s door. During multidisciplinary rounds, physicians and pharmacists calculated the PEN-FAST score and discussed allergy history with the patient. Based on risk, patients were either de-labeled from history alone, offered a single-dose 250 mg amoxicillin challenge with 90-minute monitoring, or referred to Allergy/Immunology for outpatient skin testing.<br /><br />Over a 6-month period, 157 patient encounters were reviewed. Common reported reactions were hives/rash, unspecified reactions, and anaphylaxis. Fifty-three patients were eligible for oral challenge, and 51 were offered it; 35 of those challenged (69%) tolerated amoxicillin and were de-labeled. In total, 88 patients (56%) were de-labeled, either by history or by successful challenge. Sixty-nine patients were not de-labeled, most often because their PEN-FAST score indicated moderate-high risk, they refused, or they could not be assessed.<br /><br />A 3-month follow-up found that 14 patients (9%) had been re-labeled. The initiative involved 22 physicians, 7 pharmacists, and nursing staff, and showed that a multidisciplinary rounding-based approach can safely and effectively reduce inaccurate penicillin allergy labels in the hospital setting. Limitations included inconsistent nursing involvement, staffing constraints, and difficulty standardizing outpatient referral for higher-risk patients. The authors conclude that this workflow is scalable and may improve antibiotic use, reduce costs, and enhance patient outcomes.

Asset Subtitle

Joey Saliba

Meta Tag

Author List Bryant Froberg, Joey Saliba, Rachel Cox, Tiffany Kong, Zak Tressel

Category Innovations

Concept Penicillin Allergy

Concept Penicillin Allergy De-labeling

Concept PEN-FAST Score

Concept Risk Stratification

Concept Amoxicillin Challenge

Distinguished Finalist

Presenter Organization MedOne Healthcare Partners

Presenting Author Joey Saliba

Track Quality Improvement

Keywords

penicillin allergy

de-labeling

PEN-FAST score

inpatient workflow

amoxicillin challenge

multidisciplinary rounds

allergy assessment

hospital quality improvement

antibiotic stewardship

Riverside Methodist Hospital

Penicillin Allergy

Penicillin Allergy De-labeling

PEN-FAST Score

Risk Stratification

Amoxicillin Challenge