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    Sarubbi CB, Wrenn RH, Hanna SG, Lugar PL, Kleris RS, Moehring RW, Anderson DJ

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    Sarubbi CB, Wrenn RH, Hanna SG, Lugar PL, Kleris RS, Moehring RW, Anderson DJ

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    Mr X
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    POSTER168_1570

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    Sarubbi CB, Wrenn RH, Hanna SG, Lugar PL, Kleris RS, Moehring RW, Anderson DJ

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    Poster # 1570 christina.sarubbi@duke.

    edu
    Impact of a Standardized Penicillin Allergy Assessment Program to DUMC Box 3089
    Durham, NC 27710
    Optimize Penicillin Allergy Documentation and Beta -lactam Phone: (919) 613-0943

    Antibiotic Use at an Academic Medical Center


    Sarubbi CB1,3, Wrenn RH1,3, Hanna SG1, Lugar PL2, Kleris RS3, Moehring RW4, Anderson DJ4
    1Department of Pharmacy, Duke University Hospital, Durham, NC, USA; 2Divisions of Adult and 3Pediatric Pulmonary, Allergy, & Critical Care,
    Duke University Hospital, Durham, NC; USA; 4Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC; USA

    Abstract Background Results


    Background: The 2016 IDSA Guidelines for Implementing an  Penicillin allergy is the most common reported  The mean age was 57.4 and 59.7 years in the control and interventions arms, respectively (p>0.05). The majority of the
    Antibiotic Stewardship Program recommend that Antibiotic drug allergy in medical records patients were female in both groups (68% and 57%, p>0.05).
    Stewardship Programs (ASPs) implement allergy assessments for  The average time to complete each assessment was 15-20 minutes.
    patients with a documented penicillin allergy. The impact of  Patients with reported penicillin allergies are
    completing these allergy assessments on allergy documentation often prescribed alternative antibiotics such as Table 1. Comparison of Intervention Strategies Figure 1. Aztreonam Utilization
    and antibiotic prescribing is not well characterized. vancomycin, clindamycin and
    Arm 1 Arm 2
    fluoroquinolones. p-value
    Methods: We performed a retrospective quasi-experimental study N=100 N=100
    to evaluate the impact of the implementation of a standardized  Patients who receive these agents have worse Proportion who had a change in
    31 (31) 62 (62) <0.0001
    allergy characterization, n (%)
    penicillin allergy assessment program by the Duke Antimicrobial outcomes than those who receive standard
    Stewardship and Evaluation Team (ASET). Starting in May 2015, Receipt of a b-lactam within 90
    beta-lactam therapy. days, n (%)
    24 (24) 26 (26) NS
    pharmacy technicians performed detailed assessments of admitted
    patients with a documented penicillin allergy; assessments were Proportion who had allergy
    2 (2) 7 (7) NS
    removed, n (%)
    reviewed by clinical pharmacists. The pre-intervention period
    included randomly-selected adult patients with a reported penicillin Methods Hospital-wide aztreonam utilization
    – DOT/1000 Days Present
    10.8 7.0 <0.0001
    allergy admitted from May 2014 to April 2015. The primary study
    outcome was accurate characterization of penicillin allergy within  Retrospective quasi-experimental design.
    Figure 4. Penicillin Allergy Assessment
    the electronic health record (EHR), including clarification of allergic  Pharmacy technicians and clinical interns
    reaction and removal of allergy. interviewed patients with a reported penicillin
    Results: A total of 200 patients were included; 100 patients during allergy on admission using a standardized
    the intervention period, and 100 during the pre-intervention period. questionnaire in Epic®.
    The proportion of patients who had their allergy information
     Arms were compared using c2 test.
    updated increased from 31% to 62% following implementation of
    the program (p<0.0001); inappropriate allergy documentation was
    removed in 7 (7%) patients. The program did not change the • 5/2014 through 4/2015
    percentage of study patients who received a b-lactam (24% vs • No formal Penicillin
    26%; p=0.74). Hospital-wide aztreonam use was lower in the Arm 1 Allergy Assessments
    intervention group (10.8 vs 7.0 DOT/1,000 days present; Conclusions
    p<0.0001). The average time to perform each assessment was 15 • 5/2015 through 4/2016  Use of a standardized penicillin allergy assessment had a significant impact on allergy characterization
    minutes. • Penicillin Allergy and hospital-wide aztreonam use.
    Conclusion: Implementation of a standardized penicillin allergy Arm 2 Assessment Program
     Pharmacy technicians and interns can successfully aid stewardship allergy assessment efforts.
    assessment program led to a significant impact on allergy
    documentation within the EHR without burdening pharmacy staff.  See Poster 744 for additional information and results from this penicillin allergy program.

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