Nirav Shah|Jessica P. Ridgway|Natasha N. Pettit|John Fahrenbach|Ari Robicsek
Documenting Penicillin Allergy: The Impact of Inconsistency
University of Chicago|University of Chicago|University of Chicago|NorthShore University HealthSystem|NorthShore University HealthSystem|University of Chicago
allergy documentation frequently inconsistent incomplete impact variability subsequent treatment well describedto determine allergy documentation affects subsequent antibiotic choiceretrospective cohort study232616 adult patients seen 199 primary care providers pcps january 1 2009 january 1 2014 academic medical systeminterphysician variation betalactam allergy documentation antibiotic treatment following betalactam allergy documentation156 patients reported betalactam allergy patients 398 specific allergen identified 227 allergic reaction characteristics documented variation pcps greater would expected chance p0001 percentage patients documented betalactam allergy 79 248 identification specific allergen eg amoxicillin opposed penicillins 240 582 documentation reaction characteristics 54 519 betalactam allergy documentation patients less likely receive penicillins relative risk rr 016 95 confidence interval 015017 cephalosporins rr 028 95 ci 027030 likely receive fluoroquinolones rr 15 95 ci 1516 clindamycin rr 38 95 ci 3640 vancomycin rr 50 95 ci 4358 among patients betalactam allergy rechallenge likely specific allergen identified rr 16 95 ci 1518 reaction characteristics documented rr 20 95 ci 1822provider documentation betalactam allergy highly variable details allergy infrequently documented classification patient betalactam allergic incomplete documentation regarding details allergy lead betalactam avoidance use antimicrobial agents behaviors may adversely impact care quality cost