Presenter Status
Fellow
Abstract Type
QI
Primary Mentor
Jennifer Goldman, MD
Start Date
11-5-2021 12:00 PM
End Date
11-5-2021 12:15 PM
Presentation Type
Oral Presentation
Description
Problem Statement/Question: A penicillin (PCN)-allergy label is life-long and has been shown to result in more costly, less effective, and broader-spectrum antibiotics being utilized for surgical prophylaxis. At CMH, 6.6% of surgical patients receiving perioperative antibiotics are labeled PCN-allergic. A common myth is that approximately 10% of patients with a PCN-allergy history will experience an allergic reaction if administered a cephalosporin, whereas recent observational studies have found crossreactivity rates between 0.17-0.7%. Most of these patients receive a cefazolin alternative unnecessarily. Currently, no process exists to identify and clarify PCN-allergic patients preoperatively. Data from November 2018-December 2019 found ~2.33 patients per week with a PCN-allergy label were scheduled for non-spine orthopedic surgery. Prior studies found that without clarification, 26% of patients with PCN-allergy labels received cefazolin for surgical prophylaxis.
Background/Project Intent: The primary aim of this QI initiative is to increase clarification of PCN-allergy labels in patients scheduled for non-spine orthopedic surgery using a phone interview from 0% to 80% by January 2021. Secondary aims include increasing the use of cefazolin for surgical prophylaxis when appropriate and de-labeling patients with misclassified allergies.
Methods: PDSA 1 established a process where the surgical team could refer patients to a drug safety pharmacist for review of their drug allergy label prior to surgery. PDSA 2 utilized an automated tool to obtain a list of patients with PCN-allergy labels who were scheduled for orthopedic surgery. PDSA 3 implemented allergy clarification phone interviews by the QI team. PDSA 4 refined the patient list and timing of list generation. PDSA 5 included addition of a survey via EMR to clarify the drug allergy.
Result: PDSA 1 identified 0.4 patients/week. 19 patient allergy-labels were clarified. Of the15 patients who were recommended to receive cefazolin, 3 did not receive surgical prophylaxis, 1 received a cefazolin-alternative, and 11 received cefazolin successfully. PDSA 2’s automated tool identified 2.4 patients/week. None of these patients were referred for drug allergy clarification with the physician-referral-method (PDSA 1). 75% of patients with previously clarified PCN-allergies received cefazolin, whereas 25% of patients with an “unknown severity” label received cefazolin. PDSA 3 found 2.8 patients/week. 80% of clarified labels were recommended to receive cefazolin. Patients with a clarified drug allergy label had a significantly higher proportion of receiving cefazolin (93%) when compared to patients that had not been clarified (26%; OR 3.4286; 95% CI 1.2512 to 9.3953; P = 0.0166). PDSA 4’s refined process allowed clarification of 91% of identified patients, 95% of which successfully received cefazolin. This process increased the percent of patients clarified by 27% (95% CI 9.5048% to 44.7701%; P = 0.0018). PDSA 5 implemented an electronic allergy interview that was sent to patients to further automate the interview process. 13% of surveys distributed were returned, and 50% of returned surveys required phone interviews for additional clarification.
Conclusions: Automation of identification of patients with a PCN-allergy label improves percentage of patients referred for clarification. Appropriate clarification and documentation of a PCN-allergy labels increases the use of cefazolin for surgical prophylaxis. Further strategies to standardize this process to replace or supplement phone calls could make the process more efficient
Additional Files
Optimization of Perioperative Prophylaxis in Penicillin-Allergic.pdf (167 kB)Abstract
Run chart.pptx (2933 kB)
Run chart
Included in
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Optimization of Perioperative Prophylaxis in Penicillin-Allergic Labeled Patients
Problem Statement/Question: A penicillin (PCN)-allergy label is life-long and has been shown to result in more costly, less effective, and broader-spectrum antibiotics being utilized for surgical prophylaxis. At CMH, 6.6% of surgical patients receiving perioperative antibiotics are labeled PCN-allergic. A common myth is that approximately 10% of patients with a PCN-allergy history will experience an allergic reaction if administered a cephalosporin, whereas recent observational studies have found crossreactivity rates between 0.17-0.7%. Most of these patients receive a cefazolin alternative unnecessarily. Currently, no process exists to identify and clarify PCN-allergic patients preoperatively. Data from November 2018-December 2019 found ~2.33 patients per week with a PCN-allergy label were scheduled for non-spine orthopedic surgery. Prior studies found that without clarification, 26% of patients with PCN-allergy labels received cefazolin for surgical prophylaxis.
Background/Project Intent: The primary aim of this QI initiative is to increase clarification of PCN-allergy labels in patients scheduled for non-spine orthopedic surgery using a phone interview from 0% to 80% by January 2021. Secondary aims include increasing the use of cefazolin for surgical prophylaxis when appropriate and de-labeling patients with misclassified allergies.
Methods: PDSA 1 established a process where the surgical team could refer patients to a drug safety pharmacist for review of their drug allergy label prior to surgery. PDSA 2 utilized an automated tool to obtain a list of patients with PCN-allergy labels who were scheduled for orthopedic surgery. PDSA 3 implemented allergy clarification phone interviews by the QI team. PDSA 4 refined the patient list and timing of list generation. PDSA 5 included addition of a survey via EMR to clarify the drug allergy.
Result: PDSA 1 identified 0.4 patients/week. 19 patient allergy-labels were clarified. Of the15 patients who were recommended to receive cefazolin, 3 did not receive surgical prophylaxis, 1 received a cefazolin-alternative, and 11 received cefazolin successfully. PDSA 2’s automated tool identified 2.4 patients/week. None of these patients were referred for drug allergy clarification with the physician-referral-method (PDSA 1). 75% of patients with previously clarified PCN-allergies received cefazolin, whereas 25% of patients with an “unknown severity” label received cefazolin. PDSA 3 found 2.8 patients/week. 80% of clarified labels were recommended to receive cefazolin. Patients with a clarified drug allergy label had a significantly higher proportion of receiving cefazolin (93%) when compared to patients that had not been clarified (26%; OR 3.4286; 95% CI 1.2512 to 9.3953; P = 0.0166). PDSA 4’s refined process allowed clarification of 91% of identified patients, 95% of which successfully received cefazolin. This process increased the percent of patients clarified by 27% (95% CI 9.5048% to 44.7701%; P = 0.0018). PDSA 5 implemented an electronic allergy interview that was sent to patients to further automate the interview process. 13% of surveys distributed were returned, and 50% of returned surveys required phone interviews for additional clarification.
Conclusions: Automation of identification of patients with a PCN-allergy label improves percentage of patients referred for clarification. Appropriate clarification and documentation of a PCN-allergy labels increases the use of cefazolin for surgical prophylaxis. Further strategies to standardize this process to replace or supplement phone calls could make the process more efficient
