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J Allergy Clin Immunol Pract. 2017 May - Jun;5(3):616-625.e7. doi: 10.1016/j.jaip.2017.02.019.

Addressing Inpatient Beta-Lactam Allergies: A Multihospital Implementation.

Author information

1
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Mass; Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital and the Massachusetts General Professional Organization, Boston, Mass; Harvard Medical School, Boston, Mass. Electronic address: kblumenthal1@partners.org.
2
Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Infection Control Unit, Massachusetts General Hospital, Boston, Mass; Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Mass.
3
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
4
Department of Pharmacy, Newton-Wellesley Hospital, Newton, Mass.
5
Partners HealthCare Quality, Safety, and Value, Boston, Mass.
6
Allergy Unit, Department of Medicine, North Shore Medical Center, Salem, Mass; Asthma and Allergy Affiliates, Salem, Mass.
7
Department of Pharmacy, Brigham and Women's Hospital, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
8
Department of Pharmacy, Massachusetts General Hospital, Boston, Mass.
9
Harvard Medical School, Boston, Mass; Department of Medicine, Brigham and Women's Faulkner Hospital, Boston, Mass.
10
Harvard Medical School, Boston, Mass; Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Department of Pharmacy, Brigham and Women's Hospital, Boston, Mass.
11
Partners eCare, Partners HealthCare System, Boston, Mass.
12
Division of Infectious Diseases, Department of Medicine, North Shore Medical Center, Salem, Mass.
13
Harvard Medical School, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
14
Pharmacy Department, North Shore Medical Center, Salem, Mass.
15
Pharmacy Department, Brigham and Women's Faulkner Hospital, Boston, Mass.

Abstract

Addressing inaccurate penicillin allergies is encouraged as part of antibiotic stewardship in the inpatient setting. However, implementing interventions targeted at the 10% to 15% of inpatients reporting a previous penicillin allergy can pose substantial logistic challenges. We implemented a computerized guideline for patients with reported beta-lactam allergy at 5 hospitals within a single health care system in the Boston area. In this article, we describe our implementation roadmap, including both successes achieved and challenges faced. We explain key implementation steps, including assembling a team, stakeholder engagement, developing or selecting an approach, spreading the change, establishing measures, and measuring impact. The objective was to detail the lessons learned while empowering others to be part of this important, multidisciplinary work to improve the care of patients with reported beta-lactam allergies.

KEYWORDS:

Adverse drug reaction; Allergy; Beta-lactam; Drug; Graded challenges; Guideline; Hypersensitivity; Penicillin; Policy; Quality improvement; Stewardship; Test dose

PMID:
28483315
PMCID:
PMC5484001
DOI:
10.1016/j.jaip.2017.02.019
[Indexed for MEDLINE]
Free PMC Article

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