Abstract
Background: Frontline providers frequently make time-sensitive antibiotic choices, but many feel poorly equipped to handle antibiotic allergies. Objective: We hypothesized that a digital decision support tool could improve antibiotic selection and confidence when managing β-lactam allergies. Methods: A digital decision support tool was designed to guide non-allergist providers in managing patients with β-lactam allergy labels. Non-allergists were asked to make decisions in clinical test cases without the tool, and then with it. These decisions were compared using paired t tests. Users also completed surveys assessing their confidence in managing antibiotic allergies. Results: The tool's algorithm was validated by confirming its recommendations aligned with that of five allergists. Non-allergist providers (n = 102) made antibiotic management decisions in test cases, both with and without the tool. Use of the tool increased the proportion of correct decisions from 0.41 to 0.67, a difference of 0.26 (95% CI, 0.22-0.30; P < .001). Users were more likely to give full-dose antibiotics in low-risk situations, give challenge doses in medium-risk situations, and avoid the antibiotic and/or consult allergy departments in high-risk situations. A total of 98 users (96%) said the tool would increase their confidence when choosing antibiotics for patients with allergies. Conclusions: A point-of-care clinical decision tool provides allergist-designed guidance for non-allergists and is a scalable system for addressing antibiotic allergies, irrespective of allergist availability. This tool encouraged appropriate antibiotic use in low- and medium-risk situations and increased caution in high-risk situations. A digital support tool should be considered in quality improvement and antibiotic stewardship efforts.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1243-1252.e6 |
| Journal | Journal of Allergy and Clinical Immunology: In Practice |
| Volume | 11 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 2023 |
Funding
This work was supported by the Stanford Children's Hospital Quality Improvement Grant and in part by the TADA-BSSR training grant from the National Institutes of Health National Heart, Lung, and Blood Institute (Grant No. 1T32HL151323).The authors thank the following individuals for their support in this study: Laura Bio, PharmD, BCPS, BCIDP, Department of Pharmacy, Infectious Diseases, Stanford Children's Health; Hayden Schwenk, MD, Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine; Lauren Kushner, MD, Division of Infectious Diseases, Department of Pediatrics, Stanford Children's Health; Emily Mui, PharmD, BCPS, Department of Pharmacy, Infectious Diseases, Stanford Health Care; and Denise Kwong, PharmD, BCPS, Department of Pharmacy, Medicine, Stanford Health Care. This study was reviewed by the Stanford University School of Medicine Human Research Committee and determined to be exempt/not defined as human subjects research because its primary purpose is institutional quality improvement (Protocols 54216, 54480, and 56809). The Stanford REDCap platform (http://redcap.stanford.edu) is developed and operated by the Stanford Medicine Research IT team. The REDCap platform services at Stanford are subsidized by (1) the Stanford School of Medicine Research Office, and (2) the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1 TR001085. The Qualtrics survey tool is a Web-based tool for creating and conducting surveys online. This work was supported by the Stanford Children’s Hospital Quality Improvement Grant and in part by the TADA-BSSR training grant from the National Institutes of Health National Heart, Lung, and Blood Institute (Grant No. 1T32HL151323).
Keywords
- Antibiotic allergy
- Digital tool
- Penicillin allergy
- β-Lactam allergy
ASJC Scopus subject areas
- Immunology and Allergy