Sustaining accurate penicillin allergy labels through electronic health record interoperability: a cross-sectional observational follow-up study 3 years after initial penicillin allergy evaluation.

BACKGROUND

Penicillin allergy labels (PALs) entail increased use of broad-spectrum antibiotics. Evaluating PAL is an important part of antibiotic stewardship. Sustaining correct PALs across fragmented electronic health record (EHR) systems and the dissemination of correct PALs to primary care remains a challenge. Patients’ experience of PAL evaluations and their attitude towards penicillin re-exposure is underexplored.

METHODS

We conducted a cross-sectional observational study of adults, 3 years after initial PAL evaluation at a tertiary hospital in Norway. We assessed PAL accuracy across EHR systems and examined the association between real-time EHR interoperability and sustained correct PALs. Patient experiences and attitudes towards penicillin re-exposure were explored through a structured telephone survey and analysed with systemic functional linguistics (SFL).

RESULTS

We reviewed 165 hospital records, 154 general practitioner records and surveyed 148 patients. Non-interoperable EHR systems contained 22–25% incorrect PALs, including missing PALs in patients with a confirmed penicillin allergy. EHR systems with real-time interoperability had 1–4% error rates and no cases of missing PALs in patients with a confirmed penicillin allergy. General practitioners’ records contained 8% incorrect PALs. Among 83 patients re-exposed to penicillin, 45 patients were aware of their re-exposure. SFL analysis demonstrated distinct linguistic differences between patients who reported successful de-labelling and patients with ongoing insecurities or denial of clinical result. Most patients were relieved to have their PAL examined and for their PAL to be de-labelled or confirmed. A minor cohort expressed insecurities about the validity of PAL evaluations and ongoing fear of new reactions.

DISCUSSION: In this cohort, real-time EHR interoperability was associated with more accurate PLs. Patients must be made aware of uneventful penicillin re-exposure and educated towards the validity of PAL evaluations to not only change their medical PAL status but also their cognitive and linguistic reality, to achieve sustained penicillin allergy de-labelling.