Collaboration across hospital system optimizes antibiotic use to improve patient care

Houston Methodist nurses are using an adapted screening tool at the bedside to assess whether patients have true penicillin allergies, thus enabling their care teams to offer them the most appropriate antibiotics without delay.

This ‘delabeling’ initiative, which encompasses several specialties across Houston Methodist hospitals, gives patients once considered penicillin-allergic access to life-saving medications immediately, reducing prolonged hospital stays and potentially reducing deaths.

The initiative to scrutinize penicillin allergies, led by M. Yasser Alsafadi, M.D., an infectious diseases physician and medical director of Houston Methodist’s Antimicrobial Stewardship Program, set out to re-evaluate patient penicillin allergies and delabel charts when appropriate so that patients can be given the most effective antibiotics.

Alsafadi and his team believe including frontline nurses in the re-evaluation reduces challenges doctors face when they’re unable to prescribe penicillin and its derivatives and instead must give patients second-line antibiotics that are not as effective.

“When patients are mistakenly labeled as allergic to penicillin, doctors are forced to prescribe broader-spectrum antibiotics that can be less effective, more toxic and contribute to antibiotic resistance,” Alsafadi said. The initiative harnessed the PEN-FAST clinical tool, a set of questions developed to identify patients with little to no risk of a real penicillin allergy.

“We adapted this screening tool and handed it over to our nurses, empowering them to do it on admission,” Alsafadi said. “The uniqueness of our approach is that we’re relying on a strong partnership with frontline nurses, who are the biggest workforce in the hospital, so having them as partners in this process of improving the assessment and management of penicillin allergies is very powerful.”

Penicillin allergy is one of the most commonly reported medication allergies in the U.S., with about 10% of the population reporting they are allergic to penicillin. But the CDC says only about 1% of the population is truly allergic, and most people labeled as being allergic can likely tolerate the medication safely.

Reclassifying penicillin allergies also allows physicians to give more patients the most effective antibiotics prior to surgeries. The antibiotic of choice for prophylaxis for most procedures is cefazolin, which is a cousin of penicillin, and providing it prior to surgical procedures increases the likelihood of better outcomes by preemptively fighting infections, reducing complications and ensuring faster recovery by preventing the introduction of harmful bacteria during or after surgery.

However, when a patient has a penicillin allergy label, prescribers assume the patient is allergic to all antibiotics in this family and often avoid providing cefazolin, which illustrates the indirect ramifications of these penicillin allergy mislabels.

This two-year, systemwide initiative includes Houston Methodist’s infectious diseases, nursing, pharmacy, Information Technology (IT), electronic clinical decision support, and data and analytics teams, and captures real-time statistics for sustainable and reproducible results.

Team members include Shivani Patel, Pharm.D., B.C.P.S., with the Antimicrobial Stewardship Program, and clinical infectious diseases specialist Wesley Hoffmann, Pharm.D., B.C.I.D.P.