Abstract
Introduction:
Penicillin is amongst the most commonly prescribed and reported causes of drug allergy worldwide. It is anticipated that the prevalence of true allergies is significantly less than reported. The demand for penicillin testing outweighs the available resources. Preadmission clinics offer a potentially ideal opportunity to assess patients with reported penicillin allergy in the elective surgical setting. Pharmacist-driven allergy interviews have been reported to be safe and effective in identifying inaccurate penicillin allergy labels. Using a validated clinical prediction tool by pharmacists in the preadmission clinic could identify low-risk patients in whom further testing is not needed and reduce demand on stretched resources.
Aims:
To determine the practicality and impact of preadmission pharmacists assessing penicillin allergy with a validated clinical tool on elective surgical patients.
Methods:
During a six-month period, elective surgical patients with reported penicillin allergy who presented for the preadmission clinic were assessed by the pharmacist using a validated clinical tool. The control group were patients seen in the preadmission clinic prior to implementing the tool, and their data were collected retrospectively. The main clinical outcome measures were the percentage of patients with reported penicillin allergy that the pharmacist could directly delabel using a standardised tool. The safety and accuracy in using the tool and the patients’ acceptability of pharmacists assessing penicillin allergy were also evaluated. A comparison between the observational and the interventional group in terms of surgical site infections, length of hospital stay, rate of hospital readmission and acute kidney injury were measured to determine impact of early penicillin allergy assessment.
Results:
One hundred and sixty-seven patients were included in the study, 80 in control and 87 in the intervention group. The pharmacist was able to directly delabel 26% of the patients based on allergy history alone, with 67% delabelled after referral to immunology for assessment. The pharmacist could safely and effectively use the tool in a clinic setting but has identified the need to review and improve the tool and process of delabelling. There was high acceptance from patients of this method of triaging penicillin allergy.
Conclusion:
The pharmacist is well positioned in a preadmission clinic to effectively provide penicillin allergy assessment by using the penicillin allergy assessment tool.