Holumzer, Brianna

Kile, Jarrod W, RPhD

Slenker, Amy, MD

Young, Eric, MD

Zaffiri, Kathryn, MPH

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works Research Scholars Impact of Embedded Cross-Reactivity Alert for Penicillin-Allergic Patients Brianna Holumzer Amy Slenker MD Eric Young MD Kathryn Zaffiri MPH Jarrod W. Kile RPhD Follow this and additional works at: https://scholarlyworks.lvhn.org/research-scholars  Part of the Medicine and Health Sciences Commons This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. Lehigh Valley Health Network, Allentown, Pennsylvania• Penicillin (PCN) allergies are commonly reported, but only 0.02-0.04% of the population have a true Immunoglobin E-mediated (IgE), life-threatening allergy• A true IgE-mediated reaction is characterized by hives, angioedema, anaphylaxis, wheezing, and shortness of breath1• Four percent of patients with a true penicillin allergy may have a cross-reactivity to cephalosporin antibiotics• Epic (our electronic medical record) includes an embedded cross-reactivity alert that fires when a provider prescribes a cephalosporin antibiotic to a patient with a PCN allergy • This alert does not take into account reaction type nor expected side chain cross-reactivity and is often inappropriate • Broad spectrum antibiotics are given as an alternative but can increase the likelihood of antibiotic resistance1 and adverse effects1. Joint Task Force on Practice Parameters representing the American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol. 2010 Oct;105(4):259-273. 2. Macy, E., McCormick, T. A., Adams, J. L., Crawford, W. W., Nguyen, M. T., Hoang, L., Eng, V., Davis, A. C., & McGlynn, E. A. (2021). Association Between Removal of a Warning Against Cephalosporin Use in Patients With Penicillin Allergy and Antibiotic Prescribing. JAMA network open, 4(4), e218367. https://doi.org/10.1001/jamanetworkopen.2021.8367• The alert fired inappropriately 92% of the time • Providers changed the antibiotic 48% of the time, despite the alert being appropriate only  8% of the time• Providers were more likely to override the alert for intolerances or mild reactions (64%) than for severe reactions (55%)• Certain specialties (infectious disease and pediatrics) are more comfortable with antibiotic allergy assessment  and are more likely to override the alerts• Providers with less experience in antibiotic allergy assessment, such as cardiology and surgical specialties, are more likely to remove the order and change the antibioticIntroductionMethodsResults ConclusionsFuture DirectionsImpact of Embedded Cross-Reactivity Alert for Penicillin-Allergic PatientsResearch Scholar: Brianna Holumzer Mentors: Amy Slenker, MD, Eric Young, MD, Kathryn Zaffiri, MPH, Jarrod Kile, RPhLVHN Department of Infectious DiseaseAdjust the Epic alert to be more specific and targeted based on reaction type and side chain moietyProvide training to providers on documentation of allergies and intolerancesConfigure Epic to more effectively and appropriately document allergies and intolerances• Retrospective chart review using data from Epic• Inclusion Criteria– Patients with allergies to PCN and its derivatives– November 1, 2020 – April 30, 2021– All sites, inpatient and outpatient– Patients were ordered a cephalosporin and received a cross-reactivity alert• Descriptive statistics used to analyze the dataFigure 1. The percent of the time the warning was overridden vs when the order was removed by reaction type. Reactions with N<9 were excluded. N=71, 30%N=317, 41%N=20, 53%N=380, 53%N=35, 53%N=2437, 58%N=17, 59%N=1882, 62%N=1198, 62%N=348, 65%N=3141, 65%N=17, 65%N=242, 66%N=45, 68%N=288, 72%N=302, 74%N=26, 87%N=168, 70%N=415, 59%N=18, 47%N=340, 47%N=31, 47%N=1768, 42%N=12, 41%N=1156, 38%N=729, 38%N=190, 35%N=1669, 35%N=9, 35%N=122, 34%N=21, 32%N=113, 28%N=104, 26%N=4, 13%R E S P I R A T O R Y  D I S T R E S SA N A P H Y L A X I SP A L P I T A T I O N SA N G I O E D E M AF E V E RH I V E S / U R T I C A R I AM U S C L E  P A I N / C R A M P SO T H E R  ( S E E  C O M M E N T S )U N K N O W N  R E A C T I O NI T C H I N G / P R U R I T I SC O N T A C T  D E R M A T I T I SH Y P O T E N S I O ND I A R R H E AG E N E R A L I Z E D  E D E M AN A U S E A / V O M I T I N GG I  U P S E TD I A P H O R E S I SDrug Allergy ReactionCount and Percent  of  Order  Removed vs  Warning Overr idden by Al lergy React ion% Overridden % Removed• The alert fired 14,239 times; 7,371 (52%) times the alert was overridden, and 6,806 (48%) times the order was removed• The alert fired appropriately 20.8% of the time based on expected side chain cross-reactivity and  39.7% for patients with severe allergic reactions that should preclude challenge• Overall, 8% of the alerts were appropriate based on both expected side chain reactivity and reaction typeTable 1. Count and percent of order removed vs warning overridden based on provider specialty. Some specialties were grouped together based on similarity (pediatric subspecialties, surgical specialties).

Impact of Embedded Cross-Reactivity Alert for Penicillin-Allergic Patients

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Impact of Embedded Cross-Reactivity Alert for Penicillin-Allergic Patients

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