6790 A flash audit of antibiotic allergy documentation and referral in a university teaching hospital

Objectives Ten percent of the British population reports having a penicillin allergy,1 yet, 2 Penicillin-allergic patients have higher healthcare costs and are at increased risk of nosocomial infections.3 Children with low-risk symptoms may safely undergo oral drug provocation testing with the view to delabel if successful. The Royal Devon University Hospital (RDUH) has a well-established outpatient paediatric delabeling service, but the unmet need in our population is unknown. This study aims to ascertain the burden of allergy in our acute population by performing a flash audit. Methods A prospective snapshot audit of all patients seen by the paediatric team in RDUH from 16–22 July 2023 in both the Emergency Department and Assessment Unit. The patient list was derived from electronic patient records (EPR). Details of allergy status, description and delabeling clinic referral were extracted directly from the EPR. Results There were 143 patient attendances during the study period. Of these, 90.2% (n=129) had their allergy status checked and documented contemporaneously. Where allergy was documented, 7% (n=9) were documented as allergic to penicillin. Of these n=6 were classed 'low risk', but no patients were referred for delabeling. Reactions reported are shown in table 1. During their care episode, 33.3% (n=3) of patients with documented allergies received clarithromycin where their low-risk status meant that they could have received the first-line therapy of amoxicillin. Conclusion This flash audit identifies need for improvement in the documentation of allergy status, risk-stratification and referral into specialist delabeling services. Opportunities are being missed to delabel some patients at the bedside enabling first-line therapies to be given safely. Clarithromycin was given to patients where amoxicillin was appropriate. Since clarithromycin is four times more expensive than amoxicillin,4 for those without true allergy this constitutes both an unnecessary cost and sub-optimal therapy.3 Since data was collected in July, it is likely that the actual excess cost per year is higher due to increased antibiotic prescription rates in autumn and winter. This flash audit has led to an education session and signposting for the paediatric team regarding the delabeling procedure both at bedside and via the allergy service. References Vyles D, Antoon JW, Norton A et al. Children with reported penicillin allergy: public health impact and safety of delabeling. Ann Allergy Asthma Immunol 2020;124:558–65. Solensky R, Khan DA, Bernstein IA et al. Drug allergy: an updated practice parameter. Ann Allergy Asthma Immunol 2010 Oct;105(4):259–273. Macy E, Contreras R. Health care use and serious infection prevalence associated with penicillin 'allergy' in hospitalized patients: a cohort study. J Allergy Clin Immunol 2014;133(3):790–796. South and West Devon Formulary Internet. southwest.devonformularyguidance.nhs.uk. Available from: https://southwest.devonformularyguidance.nhs.uk/formulary