Hoffmann Wesley J, Patel Shivani, Lee Elizabeth J, Finch Natalie A, Su Christy P, Teran Nicole A, Huang Yao-Hsuan, Shehadeh Fadi, Alsafadi Muhammad Yasser
Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA.
Department of Pharmacy, Houston Methodist The Woodlands, Conroe, TX, USA.
Antimicrob Steward Healthc Epidemiol. 2025 Jul 18;5(1):e159. doi: 10.1017/ash.2025.10066. eCollection 2025.
To evaluate performance of registered nurse assessments of the PEN-FAST penicillin allergy clinical decision rule compared to antimicrobial stewardship pharmacists.
Prospective, blinded, non-interventional, quality assurance study.
This study took place across 4 inpatient hospitals within a large health system in Houston, Texas.
We implemented PEN-FAST rule questions into the electronic health record (EHR) for registered nurses to perform. Patients were randomly selected in a prospective fashion, with nurse documented scores hidden, for re-assessment by antimicrobial stewardship pharmacists to compare risk stratification and scores.
Overall agreement of high risk and low risk results was 84.3%. Registered nurse evaluations with the PEN-FAST clinical decision rule for detecting a high-risk patient demonstrated a sensitivity of 67%, specificity of 89.8%, positive predictive value of 67.9%, and negative predictive value of 89.5%. Additionally, 34.4% of patients with a documented penicillin allergy admitted to tolerating amoxicillin or amoxicillin/clavulanate since their last recalled reaction to penicillin.
Registered nurse assessment of the PEN-FAST clinical decision rule demonstrated good performance and can effectively be used to screen for low-risk penicillin allergy patients. Incorporation of the PEN-FAST rule into EHR can be scaled into large health systems to help appropriately stratify patients with low- and high-risk penicillin allergies and improve documentation.
评估注册护士运用PEN-FAST青霉素过敏临床决策规则的评估表现，并与抗菌药物管理药师的评估表现进行比较。
前瞻性、盲法、非干预性质量保证研究。
本研究在得克萨斯州休斯顿一个大型医疗系统的4家住院医院开展。
我们将PEN-FAST规则问题纳入电子健康记录（EHR），由注册护士进行操作。以前瞻性方式随机选择患者，隐藏护士记录的分数，由抗菌药物管理药师重新评估，以比较风险分层和分数。
高风险和低风险结果的总体一致性为84.3%。注册护士运用PEN-FAST临床决策规则检测高风险患者的评估显示，敏感性为67%，特异性为89.8%，阳性预测值为67.9%，阴性预测值为89.5%。此外，34.4%记录有青霉素过敏的患者自上次回忆起青霉素反应后，承认能耐受阿莫西林或阿莫西林/克拉维酸。
注册护士对PEN-FAST临床决策规则的评估表现良好，可有效用于筛查低风险青霉素过敏患者。将PEN-FAST规则纳入电子健康记录可推广至大型医疗系统，以帮助对低风险和高风险青霉素过敏患者进行适当分层，并改善记录。
