A Quality Improvement Project to Decrease Inaccurate Penicillin Allergies in Resource‐Limited Ambulatory Care Clinics

ABSTRACT Background There is a lack of data on the impact of implementing an interprofessional approach in ambulatory clinics to de‐label penicillin‐allergic patients (PA) in diverse and lower‐income populations. Methods A quality improvement (QI) interprofessional adult PA assessment/intervention protocol was implemented at two resource‐limited ambulatory sites over 4 months, utilizing a post‐group‐only quasi‐experimental study design. Pharmacists performed allergy assessments/Pen‐FAST scores with nonallergic histories directly de‐labeled. Nonpregnant patients with Pen‐FAST scores less than 3 were offered amoxicillin direct oral challenges (DOC), and scores of 3 or greater were offered allergist referrals. Data collection included demographics, allergy information, Pen‐FAST score, and outcomes. The primary outcome was the percentage of interviewed patients de‐labeled. Secondary outcomes included the percentage de‐labeled through different modalities, allergist referrals, and 3‐ and 6‐month antibiotic use and relabeling. Results A total of 717 and 388 PA patients were identified at Sites 1 and 2, respectively. Interviews occurred in 228 patients, with 151 (66.2%) and 77 (33.8%) from Sites 1 and 2. The median age (interquartile range [IQR]) was 56 years (41–64), with 168 (73.7%) identified as female. A total of 130 (57%) patients had a Pen‐FAST score less than 3. Successful allergy de‐labeling was achieved in 74 of 228 (32.5%) patients. De‐labeling occurred in 60 patients by allergy assessment and 14 patients through DOC. Allergist referrals occurred in 93 patients. Of de‐labeled patients, 8 (10.8%) and 11 (14.9%) received penicillin within 3 and 6 months. Relabeling occurred in one patient within 6 months. Conclusion This QI initiative was effective in de‐labeling 33% of inaccurate PAs across two ambulatory care clinics with diverse populations.