Delabeling Penicillin Allergies in the Pediatric Primary Care Setting Through Standardized Screening

ABSTRACTKendra Martin: Delabeling Penicillin Allergies in the Pediatric Primary Care Setting Through Standardized Screening(Under the direction of Rebecca Kitzmiller)Background: Although penicillin (PCN) allergies are documented in 5–10% of children, more than 90% of labeled individuals can tolerate the medication. Erroneous PCN allergy labels lead to use of less effective broader-spectrum antibiotics, higher rates of antibiotic resistance, and increased healthcare costs. Despite the public health significance of accurate allergy documentation, most pediatric primary care settings lack standardized screening processes or provider education to support delabeling.Purpose: Over an eight-week period, this DNP project aimed to improve the accuracy of PCN allergy labels among pediatric patients at a primary care clinic associated with an academic medical center in the Southeastern United States through provider education, standardized screening, and implementation of the Penicillin Allergy Decision and Mobile Empowerment (PADME) tool.Methods: Using the Institute for Healthcare Improvement's Plan-Do-Study-Act (PDSA) framework, the project implemented three improvement cycles. Interventions included provider and staff education and integration of the PADME mobile risk-stratification tool into the patient rooming workflow via QR code. Outcome measures included PADME initiation and completion rates, providers’ allergy conversation documentation, educational material distribution, allergy and immunology referrals, and PCN allergy label removal.Results: Of 2,086 patients seen during the implementation period, 95 (4.60%) had a documented PCN allergy. Ten patients (10.5%) initiated the PADME survey and seven completed it (70%). Among completers, three (42.9%) were classified as low-risk and eligible for direct delabeling, and four (57.1%) as moderate-risk requiring referral. Providers documented PCN allergy conversations in four encounters (4.2%) and distributed educational materials in two (2.1%). No allergy labels were removed during the implementation period.Conclusion: Although no PCN allergy labels were removed, this project identified critical, addressable barriers to delabeling in a resident-led pediatric primary care setting. The PADME tool functioned as intended for patients who used it; however, the absence of EHR integration prevented risk stratification data from reaching providers at the point of care. Future efforts should prioritize EHR-embedded screening and implementation strategies tailored to the resident-led clinic context.