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Focus group study exploring the issues and the solutions to incorrect penicillin allergy-labelled patients: an antibiotic stewardship patient safety initiative
  1. Neil Powell1,
  2. Michael Wilcock1,
  3. Neil Roberts2,
  4. Jonathan Sandoe3,
  5. Sarah Tonkin-Crine4
  1. 1Pharmacy Department, Royal Cornwall Hospitals NHS Trust, Truro, UK
  2. 2Pharmacy Department, University Hositals Plymouth NHS Trust, Plymouth, UK
  3. 3Leeds Teaching Hospitals NHS Trust, Leeds, UK
  4. 4Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Neil Powell, Royal Cornwall Hospitals NHS Trust, Truro TR1 3LJ, Cornwall, UK; neil.powell2{at}nhs.net

Abstract

Objectives Approximately 10% of the general population are reported to have a penicillin allergy, but more than 90% of these patients are able to tolerate penicillins after formal assessment. Patients with penicillin allergy labels have poorer health outcomes and incorrect labels impact negatively on healthcare systems. Identifying patients with incorrect penicillin allergy labels (those who can safely take penicillin) has the potential to benefit patients and healthcare systems. This study explores barriers and enablers towards identifying and removing incorrect penicillin allergy labels in inpatients (‘delabelling’).

Methods Two focus groups were completed with a total of 17 doctors, nurses and pharmacists at a 750-bed district general hospital in England.

Results Thematic analysis identified four main themes: managing penicillin allergic patients, environmental barriers, education for patients and staff and a future delabelling process. Staff reported that identifying and delabelling incorrect penicillin allergy records was a complex task and not a priority during the acute presentation. Participants felt confident removing erroneous allergy records if the patient was able to describe the reaction. Balancing time to confirm and delabel with competing duties was felt to be a challenge. Revisiting the discussion with the patient when time was less pressured was offered as a solution to the problem. The lack of provision to translate uncertainty about allergy status in the electronic health record was mentioned as a barrier to accurate documentation of allergy history. Ensuring all patient records were amended to reflect the new allergy status was identified as a challenge. A delabelling process involving nurses, doctors and pharmacist was discussed.

Conclusions Delabelling patients with erroneous penicillin allergy labels was recognised as a complex problem. A patient pathway involving nurses, doctors and pharmacist is likely to be the optimal method to safely delabel patients.

  • penicillin allergy de-labelling
  • incorrect penicillin allergy labels
  • qualitative study
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