The majority of people (90%) who have a penicillin allergy label in their medical records do not truly have allergies. However, this misinformation is perpetuated in medical care leading to significant harms. In acute care, 15-20% of admitted patients have these inaccurate penicillin allergy labels. The harms associated with the penicillin allergy label include: suboptimal treatment outcomes for infections; longer hospital stays; more adverse drug events and drug interactions; increased risk of surgical site infections; higher risk of colonization and infection with multi-drug resistant bacteria. Our best practice includes an easily accessible structured questionnaire, followed by a triaging team for de-labelling allergies. The penicillin allergy de-labelling pathway includes clearly communicated portable record for our patients, and changes in our hospital information system and the provincial pharmacy database so that future healthcare providers can see whether the patient has a true allergy. Our streamlined de-labelling practice is scalable and is an important public health intervention to promote antimicrobial stewardship. We are now improving the pathway by minimizing the need to do penicillin skin testing and enabling more providers to “de-label penicillin allergies” efficiently, effectively and safely.
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