Document Type
Article
Publication Date
1-11-2023
Identifier
DOI: 10.1017/ash.2022.360; PMCID: PMC9879898
Abstract
Objective: Penicillin (PCN) allergy labels affect antimicrobial selection for surgical prophylaxis. We aimed to increase the percentage of cefazolin usage in patients with PCN allergy labels undergoing orthopedic surgery from 50% to 80%.
Design: Quality improvement initiative.
Setting: Children's Mercy Kansas City (CMKC), a freestanding children's hospital.
Patients: Children scheduled for an orthopedic surgery (excluding spinal surgery) at CMKC who had a PCN allergy label and received a perioperative antibiotic.
Methods: No standardized process existed to identify and clarify PCN-allergic-labeled patients preoperatively. We developed a process for patient identification combined with a pharmacist phone interview for PCN allergy clarification. In plan-do-study-act (PDSA) part 1, we implemented a computer-generated patient list. In PDSA part 2, we combined automated identification with a phone interview. In PDSA part 3, we enhanced the patient list, making it timely and concise. In PDSA part 4, we included a PCN allergy clarification electronic survey to caregivers via the electronic medical record.
Results: Cefazolin use in PCN-allergic surgical patients increased from 50% to 74% following interventions. Patients who had their PCN allergy label clarified were 4 times more likely to receive cefazolin compared to those whose allergy labels were not clarified (OR, 4.21; 95% CI, 1.68-11.61; P = 0.003). Moreover, 90% of patients received cefazolin when their PCN allergy was clarified and cefazolin was recommended. When a PCN allergy label was not clarified, only 59% of patients received cefazolin.
Conclusions: Appropriate clarification and documentation of PCN allergy labels increases the use of cefazolin for surgical prophylaxis.
Journal Title
Antimicrob Steward Healthc Epidemiol
Volume
3
Issue
1
First Page
11
Last Page
11
Recommended Citation
VanderVelde KA, Suppes SL, Gibbs KA, et al. Increasing cefazolin use for surgical prophylaxis in penicillin-allergy-labeled patients. Antimicrob Steward Healthc Epidemiol. 2023;3(1):e11. Published 2023 Jan 11. doi:10.1017/ash.2022.360
Included in
Infectious Disease Commons, Orthopedics Commons, Pediatrics Commons
Comments
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
Publisher's Link: https://doi.org/10.1017/ash.2022.360