Improving antibiotic stewardship through utilization of the PEN-FAST screening tool for surgical patients with documented penicillin allergy
Creators: name: Mandler, Hannah
Publisher: name: No Publisher Supplied
Year: 2024

description: Project Purpose: This manuscript describes a quality improvement project aiming to improve antibiotic stewardship in surgical patients with documented penicillin allergy by reducing the rate of administration of second line antibiotics in the operating room. This project took place at a 348 bed tertiary care medical center over an 8 week period. Key stakeholders within theanesthesia department were educated on the PEN-FAST screening tool in effort to increase the administration rates of first line antibiotics, reduce surgical site infections, and reduce hospital costs. The informatics department was also heavily involved in facilitating integration of the PEN-FAST screening tool into the new electronic health record (EHR), EPIC, for easy access during the anesthesia preoperative patient evaluation.Methodology: An education inservice was performed within the anesthesia department to educate anesthesia providers on the PEN-FAST screening tool and how to access it on the EHR. A retrospective chart review was conducted after 8 weeks of project implementation comparing rates of cefazolin administration to patients with a documented penicillin allergy to 8 weeks of baseline data. Investigators evaluated all patients within the total 16 week timeframe who self-reported a penicillin allergy. Inclusion criteria were CRNAs and physician anesthesiologists care for adult, non-obstetrical patients who reported a penicillin allergy and presented for surgery in the main operating rooms. Exclusion criteria were providers caring for patients with a documented IgE-mediated reaction to beta lactam antibiotics, or serious rash with systemic symptoms, blistering disorders such as Stevens-Johnson Syndrome or toxic epidermal necrolysis, and acute interstitial nephritis.Results: Baseline data from prior to implementation identified 51 out of 90 patients with penicillin allergy who received cefazolin intraoperatively. Post-implementation data revealed 39 out of 85 patients with reported penicillin allergy received cefazolin intraoperatively. Additionally, of the 11 patients reported a penicillin allergy and that a provider completed aPEN-FAST form for, 10 patients received an antibiotic. A pearson chi-squared test was performed on SPSS to determine if there is a statistically significant increase in first line antibiotics administered to surgical patients with a reported penicillin allergy and did not determine a significant increase or decrease. Compared to 56.7% of patients receiving a first line antibiotic at baseline, only 45.9% of penicillin allergic patients received a first line antibiotic after education to providers andimplementation of the PEN-FAST screening tool within the anesthesia department. Meaning, 54.1% of penicillin allergic patients still received an antibiotic preoperatively that was not cefazolin. Additionally, of the 85 penicillin allergic patients that were eligible to be screened using PEN-FAST, only 11 were actually screened by an anesthesia provider. Of those 11 patients, 10 received an antibiotic, while 1 patient did not receive any antibiotic as it was not surgically indicated. There was insufficient data to perform a correlational analysis to determine a significant relationship between utilization of the PEN-FAST screening form and the patient receiving an appropriate first line antibiotic.Implications: Despite some limitations to this quality improvement project and statistically insignificant results, investigators believe this project still has clinical significance. By continuing to educate anesthesia providers on the PEN-FAST screening tool and encouraging the use of first line antibiotics in the operating room, patients will see improvements in quality of care through reduced secondary infections and surgical site infections. This quality improvement project was received positively by key stakeholders within the project site and has the potential to grow and expand throughout the sites within the RWJBarnabas system.