Regulatory approval, implementation, and brief assessment of a pharmacist‐ and pharmacy trainee‐administered penicillin allergy assessment and skin testing program

Introduction Patients with a penicillin allergy, most of which are falsely documented, often receive alternative antibiotic therapy leading to negative outcomes. Pharmacy personnel are well‐positioned to provide allergy reconciliation and penicillin skin testing services. Objectives The purpose of this study was to describe the regulatory approval and implementation of a novel, inpatient pharmacist‐ and pharmacy trainee‐administered penicillin allergy assessment and skin testing (PAAST) service. Impact on allergy reconciliation and antibiotic use was assessed. Methods This was a retrospective cohort study describing a pharmacist‐administered PAAST program conducted at a 641‐bed tertiary care medical center in South Carolina. The primary outcome was the proportion of allergies reconciled or resolved pre‐ and post‐PAAST evaluation. The secondary outcomes were the durability of allergy removal and change in antibiotic use post‐PAAST. Results Regulatory approval from the Boards of Pharmacy, Medical Examiners, and Nursing was obtained prior to implementation of the program. There were 161 PAAST evaluations, 119 (74%) allergy assessments alone, and 42 (26%) skin tests. Proportion of patients with reconciled allergies improved from 17 (11%) pre‐PAAST to 120 (75%) post‐PAAST evaluation (P < .0001). Among 42 skin tests performed, there were no positive results, 36 (86%) negative results, and 6 (14%) indeterminate results. Antibiotic therapy was optimized in 58% (21/36) of patients with a negative skin test. Following a negative skin test, vancomycin use significantly decreased (44% pre‐test vs 17% post‐test, P = .01) while use of penicillins significantly increased (0% vs 39%, P < .0001). Among 35 patients with allergy labels resolved in the electronic health record after a negative test, there were no occurrences of relabeling among a mean of 7.6 patient encounters. Conclusion Implementation of a pharmacist‐administered PAAST service effectively streamlined antimicrobial therapy and resolved penicillin allergy labels, without relabeling. Advocating for pharmacy personnel to perform services such as PAAST should be considered in other institutions and states.