Development and implementation of a pharmacistadministered penicillin allergy assessment and skin testing service in an outpatient internal medicine clinic

Introduction: The unintended consequences of a false penicillin allergy label are well documented There are few published data on improving allergy reconciliation in the outpatient setting Research Question or Hypothesis: To assess the impact of pharmacist-administered penicillin allergy assessment on allergy reconciliation in an outpatient internal medicine (IM) clinic Study Design: Single-center, prospective, cohort study Methods: Adult patients with a documented beta-lactam allergy at an IM clinic in Columbia, South Carolina were included Pharmacy personnel (e g pharmacist, pharmacy students) contacted included patients via phone using an approved allergy assessment algorithm Patient allergies were either resolved (allergy removed from electronic health record [EHR]), reconciled (complete allergy information documented in EHR), and/or an in-person clinic visit for allergy skin testing or oral challenge was recommended Patients were surveyed on their perceptions and attitudes toward pharmacy personnel performing allergy assessment using a 5-point Likert Scale The primary endpoint was the proportion of allergies reconciled in the EHR between IM clinic standard of care and pharmacist-administered allergy assessment Secondary endpoints included the assessment of patients' perception of the process and outcomes of the allergy skin tests and oral challenges Results: Among 314 patients included, 37% of allergies were reconciled through pharmacist intervention versus 7% with standard of care (P = 0 0001) Forty-four patients were scheduled for a skin test or oral challenge Four skin tests (3 negative, 1 indeterminate) and 1 negative amoxicillin oral challenge were performed Due to COVID-19, the remainder of clinic visits were canceled Among the 94 patients reached via phone, 90% of allergies were fully reconciled in the EHR Survey results showed 99% of patients are fully comfortable (strongly agree/ agree) with a pharmacist performing allergy reconciliation Average time spent to perform allergy reconciliation was 10 3 ± 5 5 minutes Conclusion: Pharmacist-performed allergy reconciliation in an outpatient, IM clinic improves resolution of beta-lactam allergies and is well received by patients