VanderVelde Kathryn A, Suppes Sarah L, Gibbs Katherine A, Latz Kevin H, Vanderpool Angela C, El Feghaly Rana E, Goldman Jennifer L
Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri.
University of Missouri-Kansas City, Kansas City, Missouri.
Antimicrob Steward Healthc Epidemiol. 2023 Jan 11;3(1):e11. doi: 10.1017/ash.2022.360. eCollection 2023.
Penicillin (PCN) allergy labels affect antimicrobial selection for surgical prophylaxis. We aimed to increase the percentage of cefazolin usage in patients with PCN allergy labels undergoing orthopedic surgery from 50% to 80%.
Quality improvement initiative.
Children's Mercy Kansas City (CMKC), a freestanding children's hospital.
Children scheduled for an orthopedic surgery (excluding spinal surgery) at CMKC who had a PCN allergy label and received a perioperative antibiotic.
No standardized process existed to identify and clarify PCN-allergic-labeled patients preoperatively. We developed a process for patient identification combined with a pharmacist phone interview for PCN allergy clarification. In plan-do-study-act (PDSA) part 1, we implemented a computer-generated patient list. In PDSA part 2, we combined automated identification with a phone interview. In PDSA part 3, we enhanced the patient list, making it timely and concise. In PDSA part 4, we included a PCN allergy clarification electronic survey to caregivers via the electronic medical record.
Cefazolin use in PCN-allergic surgical patients increased from 50% to 74% following interventions. Patients who had their PCN allergy label clarified were 4 times more likely to receive cefazolin compared to those whose allergy labels were not clarified (OR, 4.21; 95% CI, 1.68-11.61; = 0.003). Moreover, 90% of patients received cefazolin when their PCN allergy was clarified and cefazolin was recommended. When a PCN allergy label was not clarified, only 59% of patients received cefazolin.
Appropriate clarification and documentation of PCN allergy labels increases the use of cefazolin for surgical prophylaxis.
青霉素（PCN）过敏标签会影响手术预防性抗菌药物的选择。我们旨在将接受骨科手术且有PCN过敏标签的患者中头孢唑林的使用比例从50%提高到80%。
质量改进举措。
堪萨斯城儿童慈善医院（CMKC），一家独立的儿童医院。
计划在CMKC接受骨科手术（不包括脊柱手术）且有PCN过敏标签并接受围手术期抗生素治疗的儿童。
术前不存在识别和澄清有PCN过敏标签患者的标准化流程。我们制定了一个患者识别流程，并结合药剂师电话访谈来澄清PCN过敏情况。在计划-实施-研究-改进（PDSA）的第1部分，我们实施了计算机生成的患者名单。在PDSA的第2部分，我们将自动识别与电话访谈相结合。在PDSA的第3部分，我们完善了患者名单，使其及时且简洁。在PDSA的第4部分，我们通过电子病历向护理人员发送了一份PCN过敏澄清电子调查问卷。
经过干预，PCN过敏手术患者中头孢唑林的使用比例从50%提高到了74%。与过敏标签未得到澄清的患者相比，过敏标签得到澄清的患者接受头孢唑林治疗的可能性高4倍（比值比，4.21；95%置信区间，1.68 - 11.61；P = 0.003）。此外，当PCN过敏情况得到澄清且推荐使用头孢唑林时，90%的患者接受了头孢唑林治疗。当PCN过敏标签未得到澄清时，只有59%的患者接受了头孢唑林治疗。
对PCN过敏标签进行适当的澄清和记录可增加头孢唑林用于手术预防的使用率。
