Penicillin allergies: referral and management practices of anesthesiologists

A questionnaire was designed to evaluate the referral practices of Anesthesiologists for a presumed Penicillin allergy. The preliminary study was administered as a semi-structured interview to Anesthesiology Staff Physicians and Senior Residents at Memorial University of Newfoundland. The responses were analyzed using recursive abstraction 89.5% of respondents have never referred patients for evaluation of drug allergy, although, an equal number felt a referral would be helpful. However, 47.3% said they have verbally communicated to their patients that they should speak to their Family Doctor for work up of their allergy. 21.1% of participants felt time constraint was a barrier to creating a referral; another 15.8% felt that this was the responsibility of another physician (Surgeon or Family Doctor). An additional 26.3% did not comment on barriers but stated they would just give an alternative medication rather than refer. Another 15.8% mentioned that surgery is generally imminent and would not delay surgery to a referral. All participants stated they would choose an alternative antibiotic in the case of a history of penicillin allergy. Carrying a presumed diagnosis of penicillin ‘‘allergy’’ has significant consequences on the health care system and patient outcome. Anesthesiologists in our study do inquire about specifics of allergy history, however, the referrals are virtually non-existent. As a result, anesthesiologists are prescribing more expensive antibiotics, which have higher potential for emergence of antibiotic resistance. Our future plans are to complete data collection at other centers and to develop an intervention to improve referral practices and study its impact.