Impacting Antibiotic Stewardship Through Correct Antibiotic Allergy Documentation

Problem: According to the Centers for Disease Control and Prevention (2017), 20-50% of all antibiotics prescribed in United States acute care hospitals are unnecessary or inappropriate. A simple way to prevent the misuse of antibiotics, is accurate documentation and review of patients' antibiotic allergies. Methods: In an urban community hospital emergency department, a retrospective chart review was performed to assess how many antibiotic allergies were documented without listing a reaction. Emergency department nurses' knowledge and attitudes regarding antibiotic allergy documentation were surveyed before and one month after the educational intervention. The survey contained basic knowledge questions about allergies and required nurses to give themselves a ranking from zero to 100 regarding their confidence, ability, and attitudes about antibiotic allergy documentation. Post education, average rankings for each survey question were compared with pre education averages. Results of the post education retrospective chart review were compared with pre education findings. Results: Retrospective chart review revealed that for one week of patients seen in the emergency department, 32% of antibiotic allergies reviewed and documented had a blank reaction field. One month after education was provided to nursing staff, chart review revealed 28% of antibiotics had a blank reaction field. Although more antibiotic allergies had a reaction documented post education, the difference was not statistically significant (P = 0.22). According to pre and post education surveys, the averages of nurses' self-reported attitudes regarding allergy review and patient outcomes (91.17 vs 96.89, P = 0.06), ability to impact antibiotic stewardship (88.86 vs 96.56, P = 0.03), and reported habits of checking for a reaction during antibiotic allergy documentation (76.03 vs 92.28, P = 0.01) improved by a statistically significant amount. Prior to education 83% of nurses surveyed were correctly able to identify the difference between a drug allergy and a side effect. Post education, 100% of those surveyed correctly identified the difference between a drug allergy and a side effect. However, the difference in results was not statistically significant (P = 0.07). Conclusion: Although there was no statistically significant change in complete antibiotic allergy documentation pre and post-education, there was a statistically significant change in nurses' attitudes, beliefs, and reported habits regarding antibiotic allergy documentation.