A nurse-driven penicillin allergy risk score in the preoperative setting was associated with increased cefazolin use perioperatively - 25/04/24
Abstract |
Study objective |
To characterize and assess the effects of a preoperative, nurse-driven penicillin allergy risk stratification tool on rates of perioperative cefazolin and second-line antibiotic use.
Design |
Quasi-experimental quality improvement study of penicillin-allergic surgical patients undergoing procedures for which cefazolin is indicated.
Setting |
Outpatient Perioperative Care Clinic (PCC) for preoperative surgical patients at a tertiary care center.
Patients |
670 and 1371 adult penicillin-allergic PCC attendants and non-attendants, respectively.
Intervention |
A paper penicillin allergy risk stratification questionnaire was administered during the PCC visit. Nurses were educated on its use.
Measurements |
Antibiotic (cefazolin, clindamycin, vancomycin) use rates in the 24 months before and 17 months after intervention implementation in November 2020 (November 2018 – April 2022) were assessed in penicillin-allergic PCC attendants with statistical process control charts. Multivariable logistic regression assessed antibiotic use rates pre- and post-intervention adjusting for age, sex, surgical specialty and penicillin allergy history severity. Similar analyses were done in penicillin-allergic PCC non-attendants.
Main results |
Of 670 penicillin-allergic PCC attendants, 451 (median [IQR] age, 66 (Sousa-Pinto et al., 2021 [14])) were analyzed pre-intervention and 219 (median [IQR] age, 66 (Mine et al., 1970 [13])) post-intervention. One month after implementation, process measures demonstrated an upward shift in cefazolin use for PCC attendants versus no shift or other special cause variation for PCC non-attendants. There were increased odds of cefazolin use (aOR 1.67, 95% CI [1.09–2.57], P = 0.019), decreased odds of clindamycin use (aOR 0.61, 95% CI [0.42–0.89], P = 0.010) and decreased odds of vancomycin use (aOR 0.56, 95% CI [0.35–0.88], P = 0.013) in PCC attendants post-intervention. This effect did not occur in PCC non-attendants. There was no increase in perioperative anaphylaxis post-intervention.
Conclusions |
A simple penicillin allergy risk stratification tool implemented in the preoperative setting was associated with increased use of cefazolin and decreased rates of second-line agents post implementation.
Le texte complet de cet article est disponible en PDF.Highlights |
• | A nurse-driven, penicillin allergy risk tool was added to the preoperative clinic. |
• | This penicillin allergy risk tool was associated with increased odds of cefazolin use. |
• | There was no increase in perioperative anaphylaxis. |
Keywords : Penicillin allergy, Perioperative cefazolin, Perioperative anaphylaxis, Antibiotic stewardship, Allergy services, Nurse-driven quality improvement
Plan
Vol 95
Article 111443- août 2024 Retour au numéro
Article précédent
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