Accounting for those patients who have not been seen in PAC, our results are in concordance with previous studies, which demonstrated that implementation of a similar BLAA process results in clearance of ≥ 90% of penicillin allergies.13-17Other studies have evaluated inpatient implementation of penicillin skin testing or oral challenges; in this study, however, BLAAs were completed while the patient was hospitalized, and patients were seen in PAC after discharge. Completing BLAA during hospitalization not only allows for faster assessment and facilitates decision making regarding most patients’ antibiotic regimens, but also provides a tool that can be used by many pharmacists and HCPs. The addition of our PAC to the BLAA protocol further strengthens the impact on clearance of patients’ penicillin allergies.
Limitations
Although our study demonstrates many benefits of implementation of a BLAA protocol and PAC, it has several limitations. This analysis was a retrospective review of the limited number of patients who had assessments completed. Additionally, many patients were waiting to be seen in PAC. This delay is largely due to the length of time to establish our pharmacist-run PAC, the limited number of pharmacists trained and available for skin testing, the time constraints of our staff, and COVID-19 pandemic. Additionally, only pharmacists administer the BLAA questionnaire, but this process could be expanded to other professionals such as nursing staff. Also, this study was not set up as a before-and-after analysis that examined outcomes associated with individual patients. Future directions include assessing the clinical impact of this protocol, such as evaluating provider utilization of β-lactam antibiotics for patients with penicillin allergies and determining associated cost savings.
Conclusions
This study demonstrated that implementation of a pharmacist-driven BLAA protocol and PAC can effectively remove inaccurate penicillin allergy labels and clear patients for alternative β-lactam antibiotic use. The BLAA process in conjunction with PAC will continue to be used to better evaluate, clarify, and clear patient allergies to optimize their care.