Briefly describe your antimicrobial stewardship program's initiative to verify penicillin allergies.

The UPMC Presbyterian Shadyside antimicrobial stewardship programs recently partnered with our division of allergy and immunology to create a pathway for the evaluation and management of patients with labeled penicillin allergies. Since most allergies can be clarified via thorough patient interview, we started by creating a standardized penicillin allergy assessment questionnaire. The questionnaire involves an initial review of our inpatient and outpatient electronic health record to identify any beta-lactams the patient may have been exposed to since their alleged reaction. This is followed by a patient interview to clarify the allergen, age, details of the reaction (including a description of the event, the onset in relation to medication initiation, any treatments provided, and the duration of the reaction), as well as any known subsequent exposures to other beta-lactams. The allergy tab is then updated to reflect this information in our electronic health record. If beta-lactam therapy is indicated, the clinician is then directed to a formalized pathway that guides next steps regarding beta-lactam selection and either full-dose challenge, graded challenge, or desensitization. Patients on non-beta-lactam antibiotics and carbapenems are the current targets for this initiative; however, we hope to expand this work to include patients receiving antibiotics for surgical prophylaxis.

Why did you decide to prioritize this stewardship initiative?

We prioritized this initiative given the far-reaching impact it has on patient care. Beta-lactams are front-line therapies for most infections, yet 10-15% of hospitalized patients report a penicillin allergy. This results in increased use of unnecessarily broad therapy or antibiotics from alternative classes which are associated with decreased clinical effectiveness, increased adverse effects, colonization/infection with multidrug-resistant pathogens, and increased mortality. Thus, we felt compelled to tackle this at our institution as a top antimicrobial stewardship priority.

How are you educating all hospital pharmacists on this initiative?

Hospital pharmacists and prescribers were educated via continuing education presentations, in-person conversations, prospective audit with intervention and feedback, mass email communications, and the distribution of pocket cards outlining proper allergy assessment and documentation practices. The pathway and supplemental materials are also available on our institutional intranet.

What does "Being Antibiotics Aware" mean to you?

What is your next big idea after you've clarified all the penicillin allergies?

Our next initiative will focus on transitions of care to optimize the selection of discharge antibiotics, corresponding regimens, and to limit unnecessarily prolonged durations of therapy.

Louise-Marie Oleksiuk, PharmD, BCPS

Clinical Pharmacist in Infectious Diseases and Antimicrobial Stewardship

UPMC - Presbyterian Shadyside, Pittsburgh, PA

PharmD, University of Pittsburgh School of Pharmacy

PGY1 Pharmacy Practice Residency, Allegheny General Hospital, Pittsburgh

PGY2 Infectious Diseases Residency, UPMC Presbyterian Shadyside