Creating a Feasible, Safe and Sustainable Penicillin Oral Challenge Program in a Rural Health Service.

PROBLEM: Programs that identify people with a low-risk allergy who can be safely delabeled by a direct oral challenge have emerged but are mostly reported in tertiary centres. There is limited information in the rural setting where resources are more constrained.

SETTING

A medium-sized rural health service in Victoria (Australia).

KEY MEASURES FOR IMPROVEMENT: The outcome measure was the number of patients with a low-risk penicillin allergy who completed a penicillin oral challenge.

STRATEGIES FOR CHANGE: The penicillin oral challenge program developed considered four critical workflows: choice of allergy assessment tool, identifying those with a low-risk penicillin allergy who were interested in an oral challenge, oral challenge supervision and communication of the outcome. These were tested through Plan, Do, Study, Act (PDSA) cycles.

EFFECTS OF CHANGE: Of 23 allergy assessment tools completed, fifteen revealed a low-risk allergy (PEN-FAST score 0, 1 or 2). Six people were not interested in the oral challenge and three did not have their interest recorded. Of the remaining six, four had an oral challenge (27%).

LESSONS LEARNT: Utilizing teamwork and the broad skill set of generalist rural staff, this rural health service was able to complete a penicillin oral challenge for over 25% of inpatients with a low-risk penicillin allergy.