P-1806. ABLE to De-Label: Liberating Patients from Penicillin Chart Allergies

Abstract Background The Veterans Affairs Clinical Pharmacy Practice Office Allergy to Beta Lactam Evaluation (ABLE) initiative was launched at the at the Michael E DeBakey VA Medical Center in October 2023. The primary implementation tool was a standardized note template, streamlining the documentation and assessment of penicillin allergy information. Patients who had tolerated penicillins since reaction or had side effects were eligible for immediate de-labeling. Those with unknown reactions, IgE-mediated allergies >10 years ago, or non-severe IgE-mediated allergies >5 years ago were considered candidates for penicillin allergy testing. All other reactions were considered ineligible for further evaluation. Results of ABLE intervention Results of ABLE intervention from October 2023-February 2024 Methods Patients labeled as penicillin allergic who were previously seen in ID clinic were contacted via unscheduled telephone calls to clarify allergy histories, identify opportunities for de-labeling, and provide recommendations for alternative beta-lactam use. The primary outcome was the proportion of “penicillin-allergic” patients successfully de-labeled. ABLE Intervention Flowchart Results Of 88 patients identified, 16 (18%) were deceased and 13 (15%) were de-labeled prior to ABLE implementation in October 2023. 56 of the 59 remaining patients received at least one attempt at telephone contact. 24 patients received the ABLE intervention. Of these, 8 patients (33%) were immediately de-labeled, and 1 declined to have the allergy removed despite being eligible. Another 13 patients (54%) were eligible for further allergy testing, of which 5 (21%) accepted a referral to Allergy clinic. Two patients (8%) were not eligible for further testing. One patient who was successfully de-labeled regained the penicillin allergy label. Conclusion The ABLE initiative improves antimicrobial stewardship and patient care by accurately assessing and managing penicillin allergies. These findings suggest those who are eligible for immediate de-labeling based on chart review should be prioritized for intervention. However, based on the acceptance rate of this telephonic intervention, alternative modalities of implementation should be explored. Disclosures All Authors: No reported disclosures