title: Impact of a pharmacist-driven beta-lactam allergy interview on inpatient antimicrobial therapy: A pilot project.
abstract: To determine the impact of a pharmacist-driven beta-lactam allergy interview on antimicrobial therapy.
  
  
  
  Tertiary care academic medical center.
  
  
  
  Clarification of beta-lactam allergy may expand treatment options for patients and potentially improve outcomes, reduce toxicity, and reduce costs.
  
  
  
  At our institution, a pilot service using a pharmacy resident and infectious diseases clinical pharmacist was implemented to clarify beta-lactam allergy information and, where appropriate, recommend a change to the patient's antibiotic therapy.
  
  
  
  Adult patients with a documented beta-lactam allergy who had received non-penicillin antibiotics and who had undergone a beta-lactam allergy interview were identified via pharmacy intervention data. A pharmacist interviewed these patients with the use of an internally developed allergy questionnaire. Recommendations for beta-lactam therapy were made to the patient's primary medical team based on the results of the allergy interview and factors including infection type and culture results. The primary objectives were to determine the percentage of patients successfully switched to beta-lactam therapy as a result of the drug allergy interview, to identify allergy discrepancies between the electronic medical record (EMR) and pharmacist's interview, and to quantify the acceptance rate of the pharmacist's antimicrobial recommendations after drug allergy clarification.
  
  
  
  Thirty-two patients were interviewed, and 24 were candidates for a beta-lactam recommendation. As a result of the interview, 21 patients (65.6%) were successfully switched from a non-penicillin antibiotic to a cephalosporin, carbapenem, or penicillin. A discrepancy between the EMR-reported allergy and history obtained on interview was identified in 11 patients (34.4%). Medical providers accepted 87.5% of pharmacists' antimicrobial recommendations.
  
  
  
  A pharmacist-driven beta-lactam allergy interview was effective in switching eligible patients to beta-lactam therapy and identifying discrepancies between EMR-documented allergies and confirmed allergies. Antimicrobial recommendations were well received by medical providers with a high acceptance rate.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Sigona
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Steele
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Miller
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000517:prevention & control; D057286:Electronic Health Records / Q000592:standards; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010595:Pharmacists / Q000458:organization & administration*; D064172:Pharmacy Residencies / Q000458:organization & administration; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D010865:Pilot Projects; D024382:Professional Role; D013339:Students, Pharmacy; D011795:Surveys and Questionnaires; D047090:beta-Lactams / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams