Clara Tam and Sreenath Pillai
Betsi Cadwaladr University Health Board
People with penicillin allergy label were found to have worse health outcome, with increase MRSA infection, Clostridioides difficile infection and mortality. A process for reviewing patients with penicillin allergy is necessary to prevent unavoidable harm due to incorrect penicillin allergy status.
A one page assessment was put together using existing evidenced based risk stratification tool (PEN-FAST), guidance from the British Society for Allergy and Clinical Immunology (BSACI) and the All Wales guidance for penicillin allergy de-labelling in adults in secondary care. This assessment can be used by any healthcare professional to assess whether the patient is truly allergic to penicillin based on careful history taking with patient. If the history clearly demonstrated a non-allergic reaction, the patient can be de-labelled WITHOUT the need of giving oral penicillin challenge. Our pilot showed consultation time, using the one page assessment, took less than 3 minutes. If it is identified that patient has low risks of having a true penicillin allergy and the reason for the initial penicillin record was not a true allergy symptoms. The healthcare profession will discuss removing penicillin allergy status from record with the patient, with a patient information leaflet to explain the risk and harm of false penicillin allergy. Allergy status will only be removed after patient offered their consent to do so. Allergy status on Welsh Clinical Portal will be updated with a letter sent to the GP to inform such changes.
In the next 12 months, this assessment will be rolled out across all three acute hospitals in BCUHB. This assessment can be used in any settings e.g inpatient, out-patient, pre-operation assessment clinic. The impact of this assessment will be evaluated, with an aim to extend this project to primary care in the future.
