Effectiveness of Interventions to Maintain Penicillin Allergy Label Removal As Part of an Inpatient Penicillin Allergy Testing Protocol

Rationale:  In patients with negative penicillin allergy testing, studies have shown high rates of persistence or redocumentation of the penicillin allergy label in the range of 36-49%. We evaluated the effectiveness of interventions used to maintain penicillin allergy label removal as part of an inpatient penicillin allergy testing program.

Methods:  A retrospective chart review was conducted for adult patients who had a penicillin allergy label removed after testing negative on penicillin skin testing followed by amoxicillin challenge. The effect of three interventions on the maintenance of penicillin allergy label removal was evaluated: 1. pharmacist counseling at the time of negative testing; 2. pharmacist counseling at post-discharge follow-up; and 3. a best practice advisory alert in the electronic medical record (EMR) at the time of attempted redocumentation of the penicillin allergy.

Results:  Between November 2014 and April 2016, 170 patients had negative penicillin allergy tests and follow-up within our health system at least 90 days later.  The median follow-up time was 268 days and 17 patients (10%) had redocumentation of a penicillin allergy as follows: 11/97 (11.3%) patients who received only intervention 1; 0/10 patients who received interventions 1 and 2; 5/37 (13.5%) patients who received interventions 1, 2, and 3; and 1/26 (3.8%) patients who received interventions 1 and 3.

Conclusions:  Pharmacist counseling after a negative penicillin allergy test in our program showed lower rates of redocumentation than previously reported.  Post-discharge counseling and EMR alerts may further improve this rate but a larger sample and longer follow-up is needed to confirm these findings.