Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Pharmacy department, Rake Lane, North Shields, NE29 8NH, UK.
Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Microbiology department, Rake Lane, North Shields, NE29 8NH, UK.
J Antimicrob Chemother. 2023 May 3;78(5):1241-1244. doi: 10.1093/jac/dkad081.
To develop a transferable process, CATALYST (challenging antibiotic allergystatus), to assess and challenge penicillin allergy status of inpatients within an NHS Foundation Hospital.
A multidisciplinary team (MDT) steering group reviewed existing literature and protocols enabling penicillin allergy assessment, challenge and de-labelling. Using this, they identified five key steps forming the basis of CATALYST: clinical assessment of the nature of allergy; inclusion/exclusion criteria; consent; direct oral penicillin challenge; and removal of allergy label. A pharmacist-led pilot was conducted to assess the process, during which a continuous PDSA (plan-do-study-act) cycle was observed. This included formally auditing endpoint data such as accuracy of allergy status in medical records post-intervention.
CATALYST was successfully developed with key resources produced to support clinicians. It was piloted in 304 patients, with 172 patients excluded and 132 successful allergy challenges. There was one incident of an adverse event (acute kidney injury) in the 132 successful patients, which occurred as a delayed reaction following 22 days of penicillin therapy. Only 64% of permanent records (held by GP) were appropriately updated when audited at the end of the pilot.
CATALYST is a transferable process to facilitate safe assessment, challenge and removal of spurious penicillin allergy labels. Handover between care sectors forms a key element of allergy removal to ensure all records are updated and work is needed to ensure this process is done effectively.
开发一种可转移的流程（CATALYST），以评估和挑战 NHS 基金会医院住院患者的青霉素过敏状态。
一个多学科团队（MDT）指导小组审查了现有的文献和协议，这些文献和协议允许进行青霉素过敏评估、挑战和去标签。在此基础上，他们确定了构成 CATALYST 基础的五个关键步骤：过敏性质的临床评估；纳入/排除标准；同意；直接口服青霉素挑战；以及去除过敏标签。进行了一项由药剂师主导的试点，以评估该流程，在此期间观察了一个持续的 PDSA（计划-执行-研究-行动）循环。这包括正式审核干预后医疗记录中过敏状态的准确性等终点数据。
成功开发了 CATALYST，并制作了关键资源以支持临床医生。该流程在 304 名患者中进行了试点，其中 172 名患者被排除，132 名患者成功接受了过敏挑战。在 132 名成功接受挑战的患者中，有 1 例不良事件（急性肾损伤），发生在青霉素治疗 22 天后的迟发反应。在试点结束时进行审核时，只有 64%的永久性记录（由全科医生持有）得到了适当更新。
CATALYST 是一种可转移的流程，可促进安全评估、挑战和去除虚假的青霉素过敏标签。护理部门之间的交接是去除过敏标签的关键要素，以确保所有记录都得到更新，需要开展工作以确保有效地完成该流程。
