Implementing the Addendum Guidelines for the Prevention of Peanut Allergy in a Primary Care Practice: A Quality Improvement Project
Sunday, March 4, 2018: 2:30 PM
S320CD (Convention Center)
Chloe L. Russo, MD,
RATIONALE: The “Addendum guidelines for the prevention of peanut allergy in the United States” was developed for use by both general practitioners and subspecialists. These were the first guidelines to provide the tools to help prevent development of peanut allergies. The aim of this quality improvement project was to assist a general pediatrics practice guideline implementation.

METHODS: Based in a large academic general pediatrics practice, this project targeted patients with eczema who presented for 4-6 month well-child visits. Following a 4 week audit period, a clinic-specific protocol was developed. Over the course of 6 cycles (1 week/cycle), several strategies were employed to assist in implementation of these guidelines.

RESULTS: In the audit period, the guidelines were implemented in 0% of patients. Despite interventions the first 3 cycles (email to providers, 5-minute presentation to small groups, another condensed email), implementation of guidelines remained at 0%. Guideline implementation increased to 8% after reminder cards were placed at workstations in cycle 4. Guideline implementation decreased to 0% after home peanut introduction teaching sheets were placed in clinic in cycle 5. Guideline implementation increased to 17% after real-time clinic assistance by an allergist in cycle 6.

CONCLUSIONS: While the newest guidelines for the prevention of peanut allergy simplify the approach to patients at risk for developing a peanut allergy, real-life application in a general pediatrics practice is challenging. Time constraints and provider confidence in administering new counseling are possible roadblocks. To help implementation of new guidelines, a more concrete change in workflow and further education is likely required.