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Anatomy of a successful stewardship intervention: Improving perioperative prescribing in penicillin-allergic patients

Published online by Cambridge University Press:  16 August 2021

Mary Elizabeth Sexton Open the ORCID record for Mary Elizabeth Sexton [Opens in a new window] ,
Merin Elizabeth Kuruvilla ,
Francis A. Wolf ,
Grant C. Lynde  and
Zanthia Wiley
Mary Elizabeth Sexton*
Affiliation:
Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
Merin Elizabeth Kuruvilla
Affiliation:
Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia
Francis A. Wolf
Affiliation:
Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
Grant C. Lynde
Affiliation:
Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
Zanthia Wiley
Affiliation:
Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
*
Author for correspondence: Mary Elizabeth Sexton, E-mail: marybeth.sexton@emory.edu
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Abstract

Objective:

To evaluate whether a series of quality improvement interventions to promote safe perioperative use of cephalosporins in penicillin-allergic patients improved use of first-line antibiotics and decreased costs.

Design:

Before-and-after trial following several educational interventions.

Setting:

Academic medical center.

Patients:

This study included patients undergoing a surgical procedure involving receipt of a perioperative antibiotic other than a penicillin or carbapenem between January 1, 2017, and August 31, 2019. Patients with and without a penicillin allergy label in their electronic medical record were compared with respect to the percentage who received a cephalosporin and average antibiotic cost per patient.

Methods:

A multidisciplinary team from infectious diseases, allergy, anesthesiology, surgery, and pharmacy surveyed anesthesiology providers about their use of perioperative cephalosporins in penicillin-allergic patients. Using findings from that survey, the team designed a decision-support algorithm for safe utilization and provided 2 educational forums to introduce this algorithm, emphasizing the safety of cefazolin or cefuroxime in penicillin-allergic patients without history of a severe delayed hypersensitivity reaction.

Results:

The percentage of penicillin-allergic patients receiving a perioperative cephalosporin improved from ∼34% to >80% following algorithm implementation and the associated educational interventions. This increase in cephalosporin use was associated with a ∼50% reduction in antibiotic cost per penicillin-allergic patient. No significant adverse reactions were reported.

Conclusions:

An educational antibiotic stewardship intervention produced a significant change in clinician behavior. A simple intervention can have a significant impact, although further study is needed regarding whether this response is sustained and whether an educational intervention is similarly effective in other healthcare systems.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 9 , September 2022 , pp. 1101 - 1107
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION. Preliminary data from this study were presented as an oral abstract at the SHEA conference in Boston, Massachusetts on April 26, 2019.

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