Year of Publication

2022

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Sheila Melander

Clinical Mentor

Dr. Matthew Song

Committee Member

Dr. Jacob Higgins

Abstract

Background: In an acute care setting, more than half the inpatient population receives antibiotics. Approximately 10% of the general population reports an allergy to penicillin. It has been replicated in the literature with data that of those who report a penicillin allergy, up to 95% are incorrectly identified. When a patient is admitted to the hospital with a penicillin allergy on their electronic health record, they are at higher risk for adverse events such as a hospital acquired infection, the occurrence of an antibiotic resistant bacteria related to receiving broader therapy and increased healthcare utilization.

Purpose: The purpose of this project was to address the over reporting of penicillin allergies by creating a nurse driven protocol consisting of a focused allergy history assessment to help aid with risk stratification, future de-labeling and promotion of antimicrobial stewardship.

Methods: This was a quantitative quasi-experimental study utilizing a prospective and retrospective chart review. There was a two-group pre/post intervention in which patients with reported penicillin allergies were examined 3 months prior to intervention and 3 months post implementation of the nurse led allergy de-labeling protocol admitted to four adult Norton Healthcare inpatient hospitals (Norton Hospital Downtown, Norton Brownsboro, Norton Audubon and Norton Women’s and Children).

Results: The number of patients from the pre-intervention group (n=8, 0.55%) to the post-intervention group (n=13, 0.88%) who were de-labeled increased by 62.5%. However, a chi-square statistical test was performed and revealed that there was no statistical significance (P = 0.28) in the rate of de-labeling. De-escalation occurred in 3 patients in pre versus 1 patient in post sample. Nursing documentation of patient interactions involving allergies resulted in 10 of the 21 patients de-labeled in the pre- and post-intervention sample, 47.6%. The nurse driven protocol showed 76.9% compliance and had 1131 patient interactions out of 1472 patients admitted with penicillin allergies.

Conclusion: Although there was no statistical significance between pre- and post-group samples, with no active intervention it was nonetheless determined to be an improvement. Additionally, multidisciplinary education is needed for the healthcare team to enhance compliance and promote de-labeling . In addition, developing education for the patient when allergies are de-labeled and removed from the electronic health record. Nonetheless, the nurse driven tool was successful at filling the resource gap and gathering patient data when used correctly showing the potential it has in a multi-modal de-labeling approach within the multidisciplinary team upholding that nurses are essential to antimicrobial stewardship programs and their role within should be expanded.

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