Audit of ‘true’ penicillin allergies and their documentation in Milton Keynes University Hospital (MKUH)
Authors: Kumar R , Ramm L 
Published: November 2023

Abstract

Introduction
2.7 million people are estimated to have a penicillin allergy in United Kingdom but 90% of these people are not allergic.1 In reality, only 1 in 100 patients have a ‘true’ penicillin allergy.2 These patients end up receiving alternative, less effective broad-spectrum antibiotics. This leads to a higher risk of antibiotic resistance, prolonged hospital stays, and increased healthcare costs.3 The root of this issue lies in the confusion between an allergic reaction and side effects. Findings from this audit could be used to inspire substantial cost savings, reduction in unnecessary antibiotic use, improved patient outcomes, and proper antimicrobial stewardship.

Aim
To undertake an audit with the following criteria and standards, to establish the percentage of patients that have a ‘true’ penicillin allergy as well as checking the accuracy of documentation for penicillin allergies: At least 70% of penicillin-allergic patients will have the nature of allergy documented on the trust’s electronic prescribing (eCare) system; At least 90% of penicillin allergies that are documented on the eCare system will also be documented on the Summary Care Record (SCR) system; 100% of penicillin-allergic patients will not have had penicillin therapy during their current or most recent hospital stay; A penicillin allergy label will be justified by the nature of allergy in at least 90% of patients.

Methods
This study did not require ethics approval. Data was extracted from the eCare system, consisting of penicillin-allergic patients admitted between 25/1/2023-30/1/2023. Extracted data featured the nature of allergy, reaction status and class, and antibiotic prescribed. A pilot study was undertaken using a day’s worth of data (25/1/2023). The pilot study was successful; therefore, no adjustments were made to the data collection tool.

Results
90 patients were included in the study. 63.3% (n=57) of patients had their nature of allergy documented on eCare system. 85.6% (n=77) of patients also had their penicillin allergy documented on SCR. Of the patients taking inpatient antibiotics (n=30), 93.3% (n=28) were not prescribed a penicillin during their hospital stay. 50% (n=45) of patients had a justified penicillin allergy based on the nature of allergy.

Discussion/Conclusion
None of the four objectives were achieved. This audit study proved that there are fewer patients with a ‘true’ penicillin allergy than expected. More improvement is needed for documenting the nature of allergy on the eCare system as well as justifying penicillin allergy based on the nature of allergy and other relevant factors. This can be actioned by giving training sessions to clinicians, teaching the importance of proper penicillin allergy documentation, creating a new hospital guideline to help deliver a penicillin allergy de-labelling service, and performing a re-audit after 6 months. One limitation of this study was not being able to speak to patients due to time and logistical constraints.

References
1. New BSACI guidelines for the de-labelling of Penicillin allergy [Internet]. Anaphylaxis UK. 2022 [cited 2023Mar6]. Available from: https://www.anaphylaxis.org.uk/new-bsaci-guidelines-for-the-de-labelling-of-penicillin-allergy/.
2. Pre-test information: Penicillin allergy de-labelling [Internet]. Scottish Antimicrobial Prescribing Group. [cited 2023Mar6]. Available from: https://www.sapg.scot/guidance-qi-tools/quality-improvement-tools/penicillin-allergy-de-labelling/.
3. Beeston A. Are you sure you are allergic to penicillin? [Internet]. NIHR Evidence. 2022 [cited 2023Mar6]. Available from: https://evidence.nihr.ac.uk/alert/are-you-sure-you-are-allergic-to-penicillin/.