Hospital pharmacists’ understandings of and attitudes towards beta-lactam allergies and de-labelling

Rhiannon Froude1,2

BPharm(Hons), GradCertPharmPrac | Rhiannon.Froude@mh.org.au

  1. 2022 SHPA Resident of the Year, The Society of Hospital Pharmacists of Australia, Abbotsford, Australia
  2. Clinical pharmacist, Royal Melbourne Hospital, Parkville, Australia

[Pharmacy GRIT article No: 20231388]

Beta-lactam allergies are common among hospitalised patients in Australia. My recent research explored this important issue focusing on hospital pharmacists’ understandings of and attitudes towards beta-lactam allergies and de-labelling. Research shows that while 10% of the Australian population report a penicillin allergy, less than 1% of the population are truly allergic.1 Most reported reactions can be either directly de-labelled or excluded by oral re-challenge or skin-prick testing.

Hospital pharmacists are extremely well placed to assess, document, de-label, and refer patients who report beta-lactam allergies, provided they are armed with the skills and knowledge to do so, and this understanding informed my research. I wanted to investigate whether pharmacists had the confidence and knowledge to manage patients with beta-lactam allergies and expand pharmacy practice to improve our involvement in these activities. In collaboration with antimicrobial stewardship pharmacists and an Immunology consultant, I developed an education package, a survey, a pathway for pharmacist-led immunology referral, and a formal process for pharmacist-led de-labelling. Pharmacists and interns completed the survey before and after attending the online education session, and the data from the surveys was used to assess improvement in pharmacists’ knowledge and confidence.

The results were very positive. The education session improved pharmacists’ perceived confidence in every question asked. Pharmacists demonstrated a strong baseline confidence in obtaining an allergy history, with 97% stating they felt confident to do this prior to education. However, the biggest improvement in confidence was seen in the area of identifying patients who would benefit from either oral re-challenge, immunology review, direct de-labelling or desensitisation. The improvement in these questions was statistically significant and was matched with an improvement in pharmacists’ knowledge in this area.

Being the lead on a project was a great learning experience for me. It furthered my research and communication skills and improved my clinical knowledge. I had the opportunity to see the full process of a project and was heavily involved every step of the way — developing and delivering the education package, developing the online survey, analysing the results, and collaborating with specialists. The project has impacted clinical practice at the Royal Melbourne Hospital (RMH) and has the potential for ongoing use as training for new staff or a refresher for current staff. It also has potential to be adapted for use outside the pharmacy department, either among medical teams or even at other hospitals. I am glad to have chosen a project in an area that I am passionate about, as this kept me motivated, especially when I was faced with (many) setbacks and challenges. As a direct result of the project, I was involved in teaching at Monash University and have also been delighted to be involved in the Safer Care Victoria Check Again2 project as both a member of the Expert Working Group and the RMH project team.

References

  1. Devchand M, Trubiano JA. Penicillin allergy: a practical approach to assessment and prescribing. Australian Prescriber 2019; 42: 192–9.
  2. Safer Care Victoria. Check Again. Melbourne: Victoria State Government; 2023. Available from <https://www.safercare.vic.gov.au/100000lives/projects/check-again>. Accessed 7 September 2023.