Adapting and Implementing Risk-Stratified Penicillin Allergy Evaluation in Key Outpatient Settings

Untested penicillin allergies, or “labels”, are highly prevalent, and they adversely impact healthcare quality by limiting use of guideline-recommended first-line antibiotics, thereby increasing treatment failures, drug resistance, and opportunistic infections. 10-15% of the US population carries a penicillin allergy label (PAL), but only 1 in 20 of PALs are verified as accurate after allergy testing. In previous work we developed, validated, and implemented risk-stratified management for low-risk penicillin allergy delabeling at our institution 99% NPV (95%CI 96.4, 99.9) with more than 400 patients delabeled by non-allergists to date. We now seek to extend this work using the ADAPT-ITT framework with an impact on outpatient antimicrobial stewardship by 1. measuring efficacy, barriers and facilitators of outpatient antibiotic allergy assessment for surgical, transplant and obstetric patients, 2. designing and piloting patient-centered penicillin allergy self-assessments, and 3. implementing penicillin allergy assessment in the outpatient pre-surgical environment. We hypothesize that 1. There may be additional barriers and adaptations to implement penicillin allergy risk assessment and challenges across different settings that can be overcome, leading to a model for optimal outpatient implementation of penicillin allergy risk assessment 2. That a patient performed risk-stratification questionnaire is sufficient to identify low-risk penicillin allergies and impact obstetric referrals for testing, and 3. That routinely performed penicillin allergy risk assessment will improve use of first line surgical prophylaxis. Completion of these proposed research aims would create new tools for penicillin allergy assessment delabeling efforts, new models for optimal implementation in the outpatient setting, and augment our platform for delivering drug allergy services at the points of care where they are needed most. Our multidisciplinary team is uniquely positioned to ensure the success of this undertaking.