Pharmacy Department, Royal Cornwall Hospitals NHS Trust, Truro, UK
Pharmacy Department, Royal Cornwall Hospitals NHS Trust, Truro, UK.
Eur J Hosp Pharm. 2021 Mar;28(2):71-75. doi: 10.1136/ejhpharm-2019-001863. Epub 2019 Jun 11.
Approximately 10% of the general population are reported to have a penicillin allergy, but more than 90% of these patients are able to tolerate penicillins after formal assessment. Patients with penicillin allergy labels have poorer health outcomes and incorrect labels impact negatively on healthcare systems. Identifying patients with incorrect penicillin allergy labels (those who can safely take penicillin) has the potential to benefit patients and healthcare systems. This study explores barriers and enablers towards identifying and removing incorrect penicillin allergy labels in inpatients ('delabelling').
Two focus groups were completed with a total of 17 doctors, nurses and pharmacists at a 750-bed district general hospital in England.
Thematic analysis identified four main themes: managing penicillin allergic patients, environmental barriers, education for patients and staff and a future delabelling process. Staff reported that identifying and delabelling incorrect penicillin allergy records was a complex task and not a priority during the acute presentation. Participants felt confident removing erroneous allergy records if the patient was able to describe the reaction. Balancing time to confirm and delabel with competing duties was felt to be a challenge. Revisiting the discussion with the patient when time was less pressured was offered as a solution to the problem. The lack of provision to translate uncertainty about allergy status in the electronic health record was mentioned as a barrier to accurate documentation of allergy history. Ensuring all patient records were amended to reflect the new allergy status was identified as a challenge. A delabelling process involving nurses, doctors and pharmacist was discussed.
Delabelling patients with erroneous penicillin allergy labels was recognised as a complex problem. A patient pathway involving nurses, doctors and pharmacist is likely to be the optimal method to safely delabel patients.
据报道，约有 10%的普通人群对青霉素过敏，但在经过正式评估后，超过 90%的患者能够耐受青霉素。带有青霉素过敏标签的患者健康状况较差，而错误的标签会对医疗系统产生负面影响。识别出具有不正确青霉素过敏标签（即能够安全使用青霉素的患者）有可能使患者和医疗系统受益。本研究探讨了在住院患者中识别和去除不正确青霉素过敏标签（去标签化）的障碍和促进因素。
在英格兰一家拥有 750 张床位的地区综合医院，完成了两次共 17 名医生、护士和药剂师参加的焦点小组讨论。
主题分析确定了四个主要主题：管理青霉素过敏患者、环境障碍、患者和员工的教育以及未来的去标签化流程。工作人员报告称，识别和去除不正确的青霉素过敏记录是一项复杂的任务，在急性就诊期间不是优先事项。如果患者能够描述过敏反应，工作人员有信心去除错误的过敏记录。平衡确认和去标签的时间与竞争任务的时间被认为是一个挑战。当时间压力较小时，重新讨论这个问题被认为是解决问题的一种方法。电子健康记录中缺乏对过敏状态不确定性的翻译，被认为是准确记录过敏史的障碍。确保所有患者记录都进行了修改，以反映新的过敏状态，这被认为是一个挑战。讨论了一种涉及护士、医生和药剂师的去标签化流程。
识别具有错误青霉素过敏标签的患者被认为是一个复杂的问题。涉及护士、医生和药剂师的患者路径可能是安全去标签化患者的最佳方法。
