title: Effect of a drug allergy educational program and antibiotic prescribing guideline on inpatient clinical providers' antibiotic prescribing knowledge.
abstract: BACKGROUND
  Inpatient providers have varying levels of knowledge in managing patients with drug and/or penicillin (PCN) allergy.
  
  
  OBJECTIVE
  Our objectives were (1) to survey inpatient providers to ascertain their baseline drug allergy knowledge and preparedness in caring for patients with PCN allergy, and (2) to assess the impact of an educational program paired with the implementation of a hospital-based clinical guideline.
  
  
  METHODS
  We electronically surveyed 521 inpatient providers at a tertiary care medical center at baseline and again 6 weeks after an educational initiative paired with clinical guideline implementation. The guideline informed providers on drug allergy history taking and antibiotic prescribing for inpatients with PCN or cephalosporin allergy.
  
  
  RESULTS
  Of 323 unique responders, 42% (95% CI, 37-48%) reported no prior education in drug allergy. When considering those who responded to both surveys (n = 213), we observed a significant increase in knowledge about PCN skin testing (35% vs 54%; P < .001) and loss of PCN allergy over time (54% vs 80%; P < .0001). Among those who reported attending an educational session (n = 62), preparedness to determine if an allergy was severe significantly improved (77% vs 92%; P = .03). Other areas, including understanding absolute contraindications to receiving a drug again and PCN cross-reactivity with other antimicrobials, did not improve significantly.
  
  
  CONCLUSIONS
  Inpatient providers have drug allergy knowledge deficits but are interested in tools to help them care for inpatients with drug allergies. Our educational initiative and hospital guideline implementation were associated with increased PCN allergy knowledge in several crucial areas. To improve care of inpatients with drug allergy, more research is needed to evaluate hospital policies and sustainable educational tools.
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Mass. Electronic address: kblumenthal1@partners.org.
authors.forename: Kimberly G
authors.initials: KG
authors.lastname: Blumenthal
authors.affiliation: Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Mass; Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Infection Control Unit, Massachusetts General Hospital, Boston, Mass.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Shenoy
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Shelley
authors.initials: S
authors.lastname: Hurwitz
authors.affiliation: Infection Control Unit, Massachusetts General Hospital, Boston, Mass; Department of Pharmacy, Massachusetts General Hospital, Boston, Mass.
authors.forename: Christy A
authors.initials: CA
authors.lastname: Varughese
authors.affiliation: Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Infection Control Unit, Massachusetts General Hospital, Boston, Mass.
authors.forename: David C
authors.initials: DC
authors.lastname: Hooper
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Aleena
authors.initials: A
authors.lastname: Banerji
mesh_terms: D000486:Allergy and Immunology / Q000193:education* / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003429:Cross Reactions; D004342:Drug Hypersensitivity / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004493:Education / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients; D017410:Practice Guidelines as Topic; D011364:Professional Practice; D012882:Skin Tests
chemical_list: D000900:Anti-Bacterial Agents
keywords: Allergy; Anaphylaxis; Antibiotic; Antibiotic allergy; Cephalosporin; Drug; Drug allergy; Hypersensitivity; IgE mediated; Immune-mediated; Inpatient; Penicillin