Effect of a Drug Allergy Educational Program and Antibiotic Prescribing Guideline on Inpatient Clinical Providers’ Antibiotic Prescribing Knowledge

• Published in: The journal of allergy and clinical immunology in practice (Cambridge, MA) Vol. 2; no. 4; pp. 407 - 413
• Main Authors: Blumenthal, Kimberly G., MD, Shenoy, Erica S., MD, PhD, Hurwitz, Shelley, PhD, Varughese, Christy A., PharmD, Hooper, David C., MD, Banerji, Aleena, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2014; Elsevier Limited
• Subjects: Allergies; Allergy; Allergy and Immunology; Allergy and Immunology - education; Allergy and Immunology - statistics & numerical data; Anaphylaxis; Anti-Bacterial Agents - therapeutic use; Antibiotic; Antibiotic allergy; Antibiotics; Antimicrobial agents; Bone surgery; Cephalosporin; Computerized physician order entry; Cross Reactions; Drug; Drug allergy; Drug Hypersensitivity - drug therapy; Drug Hypersensitivity - epidemiology; Drug Hypersensitivity - immunology; Drug Prescriptions - statistics & numerical data; Education; Education - methods; Follow-Up Studies; Humans; Hypersensitivity; IgE mediated; Immune-mediated; Infectious diseases; Inpatient; Inpatients; Internal Medicine; Patients; Penicillin; Practice Guidelines as Topic; Professional Practice; Skin Tests; Statistical methods; Studies; Drug; Allergy; Nurse practioner; NP; Hypersensitivity; HSR; Immune-mediated; Medical doctor; Cephalosporin; Hypersensitivity reaction; Drug allergy; Antibiotic; Anaphylaxis; Penicillin; MD; Inpatient; Antibiotic allergy; PCN; IgE mediated
• ISSN: 2213-2198; 2213-2201
• DOI: 10.1016/j.jaip.2014.02.003

Background Inpatient providers have varying levels of knowledge in managing patients with drug and/or penicillin (PCN) allergy. Objectives Our objectives were (1) to survey inpatient providers to ascertain their baseline drug allergy knowledge and preparedness in caring for patients with PCN allergy, and (2) to assess the impact of an educational program paired with the implementation of a hospital-based clinical guideline. Methods We electronically surveyed 521 inpatient providers at a tertiary care medical center at baseline and again 6 weeks after an educational initiative paired with clinical guideline implementation. The guideline informed providers on drug allergy history taking and antibiotic prescribing for inpatients with PCN or cephalosporin allergy. Results Of 323 unique responders, 42% (95% CI, 37-48%) reported no prior education in drug allergy. When considering those who responded to both surveys (n = 213), we observed a significant increase in knowledge about PCN skin testing (35% vs 54%; P < .001) and loss of PCN allergy over time (54% vs 80%; P < .0001). Among those who reported attending an educational session (n = 62), preparedness to determine if an allergy was severe significantly improved (77% vs 92%; P  = .03). Other areas, including understanding absolute contraindications to receiving a drug again and PCN cross-reactivity with other antimicrobials, did not improve significantly. Conclusions Inpatient providers have drug allergy knowledge deficits but are interested in tools to help them care for inpatients with drug allergies. Our educational initiative and hospital guideline implementation were associated with increased PCN allergy knowledge in several crucial areas. To improve care of inpatients with drug allergy, more research is needed to evaluate hospital policies and sustainable educational tools.