No abstract

Up to 10% of hospitalized patients report an allergy to penicillin (PCN). However, over 90% of patients with a reported PCN allergy do not have a true allergy. False reporting can lead to overuse of non-preferred broad-spectrum antibiotics and poorer clinical outcomes. We developed a multidisciplinary protocol for PCN skin testing for hospitalized patients with a documented PCN allergy. Feasibility and impact of this protocol were assessed to determine the necessary resources for broader implementation. METHODS: A pilot study was conducted at Michigan Medicine from July 2018 to January 2019. Patients with PCN allergy were identified from hospitalist and infectious disease services. PCN skin test was performed after screening. Patients' outpatient pharmacies and PCPs were notified of the result and rates of penicillin allergy re-labeling were monitored. RESULTS: 5 of 56 patients tested had negative PCN skin test results. Of those, 16 (29%) switched antibiotics, 19 (35%) were not on antibiotics, 17 (31%) were on appropriate antibiotics, and 3 (5.4%) were not switched due to other factors. 4 PICC lines were avoided. 15 additional patients had the PCN allergy label removed without testing based on prior use. Out of 115 pharmacists contacted, 72 (62.6%) pharmacists deleted the PCN allergy in the pharmacy record. All but 2 patients' PCPs were contacted via EMR, letter or fax. Only 3 of 55 patients (5.45%) were re-labeled with a PCN allergy after six months. CONCLUSIONS: An inpatient PCN testing program was designed and successfully executed to optimize current antibiotic stewardship practices and prevent PCN allergy re-labels.

Background: Patient-controlled analgesia (PCA) pumps are complex medical devices frequently used for postoperative pain control. Differences in how nurses program PCA pumps can lead to preventable medication errors. Purpose: To describe similarities and differences in how surgical nurses program PCA pumps. Methods: We conducted a qualitative study using video reflexive ethnography (VRE) to film nurses as they programmed a PCA pump. We spliced and collated videos into separate clips and showed to nursing leaders for their deliberation and action. Results: We found nurses ignored or immediately silenced alarms, were uncertain about the correct programming sequence, and interpreted how to load a syringe in the pump in multiple ways; in addition, the PCA pump design did not align with nurses' workflow. Conclusions: VRE was effective in visualizing common challenges nurses experienced during PCA pump programming. Nursing leaders are planning several nursing process changes due to these findings.