P2.O299: Reducing Inappropriate Penicillin Allergy Labels in Outpatient Pediatrics

Purpose/Objectives: About 5 million children in the U.S. are labeled with a penicillin allergy, yet up to 90% do not have a true allergy and approximately 80% with a true allergy lose their sensitivity after 10 years. This erroneous labeling leads to substandard antibiotics therapy, increased antibiotics resistance rates, and higher healthcare costs. The objective of our study is thus to reduce inappropriate patient penicillin allergy labels through comprehensive evaluation by 10% from September 2021 to June 2024, with the global aim to reduce inappropriate penicillin allergy labeling in children.

Design/Methods: We created a multidisciplinary team of generalists, specialists, residents, and medical students. Our first intervention revolved around provider education of penicillin allergy and appropriate allergist referral. The first provider education intervention involved attending physicians and the second involved resident physicians. Our third intervention utilized pre-visit preparation and morning team "huddles" to highlight specific patients who were presenting for well visits and were labeled as having penicillin allergy. Providers utilized a penicillin allergy questionnaire to delve in penicillin allergy history and utilizing specific criteria from the history patients who were deemed "no-risk" or "low risk" were delabeled in the primary care office. Providers referred patients with "medium" or "high" risk to an allergist. Allergists then conducted an initial intake and a follow up visit for oral amoxicillin challenge or skin testing. Our Process Measure was the percentage of patients with a penicillin allergy label assessed in the primary pediatrics office and de-labeled in the office or referred for further allergy testing, while our Outcome Measure was the percentage of patients successfully de-labeled in the clinic or allergy office.

Results: Since September 2022, 121 patients with penicillin allergy label were seen for well visit. Of these, 14 patients were delabeled in the the primary pediatrics office. 31 patients were referred to allergy. A median referral rate of 26% is noted. 25/31 patients were seen by allergist. 14/25 came back for a follow up visit and 13 were successfully delabeled. To date 22.3% of patients have been successfully delabeled.

Conclusion/Discussion: The project has successfully delabeled pediatric patients with inappropriate penicillin allergy labels. Challenges encountered include utilization of the questionnaire by more providers in order to increase in-office de-labeling and referrals to a pediatric allergist when appropriate, as well as follow through for those patients who are referred. There are also opportunities to streamline allergist workflow since many patients did not return for second visit. Identifying and reducing barriers to care that may prevent patients from a second follow up is critical. Overall, through our interventions there has been improvement in our overall approach towards ambulatory antibiotic stewardship.