P78 Implementation of a penicillin allergy de-labelling policy at a tertiary hospital

Abstract Background Following national antimicrobial stewardship initiatives highlighting the risks associated with penicillin allergy labels s well as BSACI guidelines on the provision of a penicillin allergy de-labelling service aimed at clinicians who are not trained in immunology or allergy, a penicillin allergy de-labelling policy was needed for the evaluation and testing of patients at our Trust with unverified labels of penicillin allergies. This provides a framework for administering a non-specialist drug provocation challenge test to safely establish whether a patient has a true penicillin allergy or not. The evidence behind why spurious penicillin allergy labels should be investigated and removed includes the fact that when formally assessed, over 90% of patients labelled as allergic are in fact not. Penicillin allergy labels are associated with increased healthcare costs, length of inpatient stays, and patient mortality. A penicillin allergy diagnosis increases the risk of MRSA, C Difficile and VRE infections and also leads to higher use of WHO Watch and Reserve listed antibiotics which drives antimicrobial resistance. Ultimately, the de-labelling service is a key strategy for improving patient outcomes and antimicrobial stewardship at LHCH. Objectives To implement a successful penicillin allergy de-labelling protocol for administering a test dose of penicillin in patients, without requiring input from an allergist or immunologist; to write an evidence-based penicillin allergy de-labelling protocol; to educate clinicians on how to conduct a penicillin allergy de-labelling drug provocation challenge test; and to develop electronic prescribing tools to support documentation, prescription and administration of penicillin allergy de-labelling drug provocation challenge test. Methods A penicillin allergy de-labelling protocol was published by the lead antimicrobial pharmacist, which the microbiology team promoted and directed clinicians towards whilst conducting microbiology ward rounds three times a week. From our electronic prescribing system, data on the use of the penicillin allergy de-labelling order set was ran by our internal audit team to establish how many patients were de-labelled during the year of 2024. The medication charts were reviewed to establish what the outcomes of the test dose were and whether penicillin-based treatment was utilized. The penicillin allergy records of patients who were based within the Cheshire and Merseyside ICB were reviewed by a primary care pharmacist. Standards How many penicillin provocation challenge test doses were prescribed using the electronic prescribing order set versus without. How many patients were successfully de-labelled as an inpatient. How many patients were treated with penicillin-based antibiotics as an inpatient, following the de-labelling drug provocation challenge test. How many patients were successfully de-labelled on discharge by their primary care team (in the Cheshire and Merseyside ICB). Results A total of 11 patients were successfully de-labelled as an inpatient in 2024, and of the 4 patients under the Cheshire and Merseyside ICB, only 1 patient was successfully de-labelled on their primary care records. Conclusions The de-labelling protocol and order set has been a success within our Trust, leading to optimal antibiotic regimens, however this is not being actioned within the community to improve future outcomes for patients. Recommendations (i) The communication between the Trust, patient and GP surgeries to be strengthened with the use of the newly established ‘NHS C&M Penicillin Allergy De-labelling Communication Form’. (ii) A Trust-wide staff engagement project to establish prescribing habits and confidence around penicillin allergy de-labelling.