Beta Lactam Allergy Assessment: Saving Lives One Assessment at a Time
Last updated
Share PrintBeta lactam (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 a true allergy. By clearing or clarifying these allergies using the BL assessment and skin test clinic we can decrease the incidence of multi-drug resistant infections, decrease treatment failures, decrease hospital length of stay, and save money.
Origin:
November 2016, Memphis VA Medical Center
Adoptions:
3 successful, 2 in-progress
Awards and Recognition:
Tennessee Pharmacist Association Innovative Pharmacist of the Year , iNET Spread Investee, VHA Shark Tank Winner
Recent Updates
Overview
The 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
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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.
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The solution
Based on the outcomes of the internal study, a pharmacist driven BL 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
- Take a look at how our facility implemented the Beta Lactam Allergy Assessment at the Memphis VAMC
The results
Currently 278 Veterans have been assessed using the BL template and 32 Veterans have been seen in the pharmacist ran penicillin skin test clinic. To date 99% of patients assessed have been cleared to use an alternative beta lactam type antibiotic. Out of the 184 patients whose allergies were unable to be removed via the BL assessment alone, 149 (81%) are
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Currently 278 Veterans have been assessed using the BL template and 32 Veterans have been seen in the pharmacist ran penicillin skin test clinic. To date 99% of patients assessed have been cleared to use an alternative beta lactam type antibiotic. Out of the 184 patients whose allergies were unable to be removed via the BL assessment alone, 149 (81%) are still eligible for penicillin skin test clinic, but awaiting scheduling. As more patients are seen in clinic more penicillin allergies will be able to be removed.
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Metrics
- A in-house cost avoidance assessment was performed. We estimate ~$1200 saved by each successful assessment.
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
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3-4 months
1 -2 months to implement template (includes CPS education and SOP approval)1-2 months to implement pharmacist lead skin test clinic (includes CPS training and addition to scope)
Departments
- Pharmacy
- Allergy, asthma and immunology
- Infectious disease
Core Resources
| Resource type | Resource description |
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PEOPLE |
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PROCESSES |
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TOOLS |
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Files
- Brief description of practice, results, and resources needed to implement Beta Lactam Allergy Assessment Overview
- Overview of where the template can be found in the patient's chart, what the template looks like, and what it entails. Beta Lactam Allergy Assessment Template
- Patient considerations prior to penicillin skin testing clinic and risk stratification. Penicillin Skin Testing Allergy Clinic
Support Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
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Files
- Provides background on the BLAA Promising Practice and instructions for how to implement this practice at your facility. Beta Lactam Allergy Assessments Implementation Toolkit
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
Whitney Elliott, Pharm.D., BCPS, BCGP
Inpatient 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
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