Last updated 2024-09-16T20:35:20Z

Allergy to Beta Lactam Evaluation (ABLE)

While penicillin antibiotics are one of the most common medication allergies in the United States, nearly 90% of people who report a penicillin allergy do not have a true IgE mediated allergic reaction. This misconception results in using non-preferred antibiotics, leading to antimicrobial resistance and treatment failure.

The Allergy to Beta Lactam Evaluation (ABLE) initiative consists of a standardized template and note title for pharmacists to effectively and efficiently evaluate and clarify patient penicillin allergies. The ABLE template guides the pharmacist through the allergy history to provide recommendations on alternative beta lactam use. In some cases, the ABLE template can facilitate penicillin allergy removal, also known as de-labeling. Although not all allergies can be removed using the ABLE template alone, the ABLE template does provide guidance on further penicillin allergy testing recommendations, if appropriate for the patient.

Along with the template, the ABLE initiative provides opportunities to implement a penicillin skin testing clinic and/or an inpatient amoxicillin oral drug challenge program for low-risk allergies.

For more information on how to implement this practice at your VA, please visit https://dvagov.sharepoint.com/sites/VHAClinicalPharmacy/SitePages/Allergy-to-Beta-Lactam-Evaluation-(ABLE).aspx.

Origin:

November 2016, Lt. Col. Luke Weathers, Jr. VA Medical Center (Memphis)

Adoptions:

43 successful

Awards and Recognition:

Tennessee Pharmacist Association Innovative Pharmacist of the Year , iNET Spread Investee, VHA Shark Tank Winner

Partners:

Clinical Pharmacy Practice Office, Diffusion of Excellence, VHA Innovators Network

Overview

Problem

Antibiotic resistance is a growing problem in the United States. Data has shown that more than 2 million Americans are infected every year with drug resistant organisms, increasing length of stay and billions in direct healthcare costs. Beta lactam (BL) antibiotics, or commonly called penicillin type antibiotics, have long been the drugs of choice for a majo ... Antibiotic resistance is a growing problem in the United States. Data has shown that more than 2 million Americans are infected every year with drug resistant organisms, increasing length of stay and billions in direct healthcare costs. Beta lactam (BL) antibiotics, or commonly called penicillin type antibiotics, have long been the drugs of choice for a majority of infections. This can present an issue in BL allergic patients. BL allergies are among the most commonly reported drug allergies, with ~10% of patients reporting an allergy to one or more BL antibiotics. However, nearly 90% of these patients do not demonstrate true allergies. This often leads providers to use non-preferred antibiotics which can increase treatment failure, in-hospital mortality, length of stay, rates of Clostridium difficile and multi-drug resistant infections. Review of Memphis VAMC antibiotic prescribing practices in patients with BL allergies performed in 2017-2018 demonstrated patients with BL allergies received inappropriate or non-preferred antibiotics over 50% of the time. See more

Solution

Based on the outcomes of the internal study, a pharmacist driven penicillin allergy assessment and penicillin skin testing clinic was established to clarify and clear patients BL allergies. This has helped minimize adverse patient outcomes associated with being labeled as being allergic to penicillin type antibiotics.

Links

Ready to implement ABLE in your practice at the VA? Check out our SharePoint page!

Results

In 2022, the ABLE team partnered with the VA Clinical Pharmacy Practice Office (CPPO) to further develop a diffusion and sustainment model to scale spread the ABLE Initiative with voluntary participation on a national level. The CPPO ABLE Task Force was formed, which was a collaboration of key stakeholders including Allergy and Immunology, Antimicrobial Stew ... In 2022, the ABLE team partnered with the VA Clinical Pharmacy Practice Office (CPPO) to further develop a diffusion and sustainment model to scale spread the ABLE Initiative with voluntary participation on a national level. The CPPO ABLE Task Force was formed, which was a collaboration of key stakeholders including Allergy and Immunology, Antimicrobial Stewardship Task Force, Infectious Diseases and Academic Detailing. The team successfully designed and completed a 90-day ABLE pilot from October 2022 to January 2023, in which 11 sites from 6 Veterans Integrated Services Networks (VISNs) participated. The Clinical Pharmacy Practitioners (CPPs) evaluated 262 penicillin allergic patients using the standardized ABLE template. The pilot revealed that the ABLE template was able to facilitate removal of 17% of penicillin allergies. Subsequently, 81% of patients were eligible for an alternative beta lactam antibiotic, with only 2% of patients needing to avoid all beta lactams. Of the patients whose allergy was not removed, 78% were eligible for further testing to potentially remove their penicillin allergy. Based on feedback, the ABLE template was updated and streamlined for optimal use. See more

Metrics

An in-house cost avoidance assessment was performed circa 2018. We estimate approximately $1200 saved by each successful assessment.

Diffusion tracker

Does not include Clinical Resource Hubs (CRH)

There are no in-progress adoptions for this innovation.

There are no unsuccessful adoptions for this innovation.

Implementation

Timeline

3-4 months

1 -2 months to implement ABLE template

1-2 months to implement pharmacist-led skin test clinic and/or inpatient amoxicillin oral drug challenge

Departments

Pharmacy
Allergy, asthma and immunology
Infectious disease

Core Resources

Resource type	Resource description
PEOPLE	Please view our ABLE Initiative Toolkit on our SharePoint page for resources: https://dvagov.sharepoint.com/sites/VHAClinicalPharmacy/SitePages/Allergy-to-Beta-Lactam-Evaluation-(ABLE).aspx
PROCESSES	Penicillin skin test training
TOOLS	Penicillin Skin Test Supplies

Support Resources

Resource type	Resource description
PEOPLE	Memphis will provide resources for education. We will be available to train current staff on the use of the template and provide all resources for competency.

Contact

Comment

Comments and replies are disabled for retired innovations and non-VA users.

Email

Email VHAVHAPBMCPPOABLEInitiative@va.gov with questions about this innovation.

About

Origin story

Our antimicrobial stewardship pharmacist noticed an increasing trend in the use of carbapenem antibiotics at the VAMC Memphis. It was discovered that a penicillin allergy label was a significant driving factor. These findings led to a discussion on ways we could promote appropriate antibiotic prescribing practices, which then led to a systematic review of ... Our antimicrobial stewardship pharmacist noticed an increasing trend in the use of carbapenem antibiotics at the VAMC Memphis. It was discovered that a penicillin allergy label was a significant driving factor. These findings led to a discussion on ways we could promote appropriate antibiotic prescribing practices, which then led to a systematic review of both inpatient and outpatient antibiotic prescribing to determine the extent of the problem. Review of the Memphis VAMC antibiotic prescribing practices in patients with BL allergies was performed in 2017-2018. Results of this study demonstrated that patients with BL allergies received inappropriate or non-preferred antibiotics over 50% of the time. From this, the BL allergy assessment was developed by pharmacy in conjunction with Allergy and Immunology (A&I). The assessment became a way to systematically review patients with BL allergies and clarify or clear this allergy. If certain criteria was met, then the patient was referred to A&I clinic for penicillin skin testing. We soon discovered that the amount of patients who qualified for clinic exceeded the amount of appointments available by A&I. We then created the pharmacist ran penicillin skin testing clinic. This improved patient access and removed the burdon from our A&I colleagues.

Original team

Jessica Bennett, Pharm.D.

Clinical Pharmacy Specialist - Antimicrobial Stewardship

Amanda R. Gillion, Pharm.D., BCPS

Acute Care Clinical Pharmacy Supervisor

Jarred Bowden, Pharm.D., BCIDP, AAHIVP

Clinical Pharmacy Specialist - Infectious Disease

Debendra N. Pattanaik, MD, MBBS, FACR, FAAAI

Allergy and Immunology Specialist

Anna B. Mitchell, Pharm.D., BCPS

Clinical Pharmacy Specialist

Search tags

Access to Care Continuity of Care Coordinated Care High Reliability Inpatient Care Medication Management Pharmacy Primary Care Veteran Experience Whole Health

We’re here anytime, day or night – 24/7