Decreasing False Penicillin Allergy Labels in Pediatric Populations Within a Health System Quality Improvement Project

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Abstract Corresponding Author Julie Martin, Medical College of Georgia, Augusta University/University of Georgia Medical Partnership, Athens, Georgia, USA, Phone: +1 (706) 202-2632, e-mail: jsmartin@uga.edu Funding This work was supported by the Medical Scholars Program hosted by the Augusta University/University of Georgia Medical Partnership in Athens, Georgia, US. Conflict(s) of Interest No Conflict Background Up to 95% of pediatric penicillin allergy labels are inaccurate, leading to broader spectrum antibiotic usage and subsequent antibiotic resistance, adverse drug reactions, and higher costs. This study evaluated the utility of individualized key driver diagrams, provider-driven Plan-Do-Study-Act (PDSA) cycles tailored to clinic workflows, and visual aids in removing inaccurate penicillin allergy labels. Results were compared within a health system quality improvement initiative to identify high-impact interventions and factors for successful quality improvement. Methods Baseline allergy data were collected retrospectively from each site-specific EMR, and monthly audits tracked the prevalence and details of allergy histories, with results plotted in run charts to assess trends after interventions. 15 Participating providers from outpatient pediatric clinics each developed 2 distinct PDSA cycles guided by individualized key driver diagrams (KDDs) and provided examples of visual aids such as worksheets, flyers, and EMR smart phrases. The primary outcome measure was penicillin allergy rate (PAR). Process measures included: detailed allergy rate, identified allergist for referral and physician outlook surveys. Results Baseline median PAR was 7.7%, detailed allergy rate 40%. By the end of the 6-month intervention period, PAR was 5.2% and the detailed allergy rate was 71%. 54 patients were de-labeled by history alone, and 222 patients were identified as eligible for oral challenge. Successful initiatives fell into three categories: staff involvement in patient flagging, standardized history documentation, and family education. Conclusion This project identified effective change ideas that led to increased detailed allergy histories with a subsequent drop in the PAR among outpatient pediatric patients within a health system quality improvement initiative. Sample PDSA cycles, compiled KDDs, and patient-focused visual aids support the potential for future pediatric de-allergy initiatives, including piloting in-clinic oral challenges and evaluating standardized toolkits.