Barriers to penicillin allergy de-labeling in the inpatient and outpatient settings: a qualitative study.
Barriers to penicillin allergy de-labeling in the inpatient and outpatient settings: a qualitative study.
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DOI：
10.1186/s13223-023-00842-y
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发表时间：
2023-10-11
影响因子：
2.7
通讯作者：
Kakumanu, Sujani
中科院分区：
文献类型：
--
作者：
Alagoz, Esra;Saucke, Megan;Balasubramanian, Prakash;Lata, Paul;Liebenstein, Tyler;Kakumanu, Sujani
关键词：
青霉素过敏是美国最常见的药物过敏。尽管有证据表明高达90%的标签是不正确的，但可扩展的干预措施尚未得到很好的确立。作为一项大型混合方法调查的一部分，我们进行了一项定性研究，以描述在单一地点退伍军人医院实施基于风险的青霉素去标签方案的障碍。我们对多学科住院和门诊医疗团队进行了个人和小组访谈。访谈指南使用理论领域框架（TDF）开发，以探索影响青霉素过敏患者识别和评估的工作流程和背景因素。三位研究人员迭代开发了基于TDF域的代码本，并使用主题分析对数据进行编码。我们采访了20位临床医生。参与者包括三名医院医生、五名住院药剂师、一名传染病医生、两名抗微生物管理药剂师、四名初级保健提供者、两名门诊药剂师、两名住院医生和一名过敏服务的护士病例管理人员。导致青霉素过敏评价和去标签障碍的因素分为6个TDF域；知识，技能，对能力的信念，对结果的信念，职业角色和身份，以及环境背景和资源。所有小组的参与者都承认青霉素去标签化的重要性。然而，他们对自己进行必要评估的技能缺乏信心，例如测试剂量挑战。由于担心引起过敏反应和进一步增加病人护理的复杂性，他们更不愿意给病人去标签。缺乏去标签倡议的所有权是建立一致的临床工作流程的另一个重大障碍。此外，繁重的工作量、相互竞争的优先事项以及易于获得替代抗生素阻碍了与去标签相关的任务的优先排序。空间限制和护理人员短缺增加了门诊设置的挑战。我们的研究结果表明，青霉素过敏去标签化的障碍属于多个行为领域。为了克服这些障碍，需要更好地澄清角色、发展必要技能的机会和专门的资源。未来的干预措施需要采用一种系统的方法，在住院和门诊医疗团队的利益相关者参与下，解决影响青霉素过敏去标签的每个行为领域。在线版本包含补充材料，可在10.1186/s13223-023-00842-y获得。
Penicillin allergy is the most commonly reported drug allergy in the US. Despite evidence demonstrating that up to 90% of labels are incorrect, scalable interventions are not well established. As part of a larger mixed methods investigation, we conducted a qualitative study to describe the barriers to implementing a risk-based penicillin de-labeling protocol within a single site Veteran’s hospital. We conducted individual and group interviews with multidisciplinary inpatient and outpatient healthcare teams. The interview guides were developed using the Theoretical Domains Framework (TDF) to explore workflows and contextual factors influencing identification and evaluation of patients with penicillin allergy. Three researchers iteratively developed the codebook based on TDF domains and coded the data using thematic analysis. We interviewed 20 clinicians. Participants included three hospitalists, five inpatient pharmacists, one infectious disease physician, two anti-microbial stewardship pharmacists, four primary care providers, two outpatient pharmacists, two resident physicians, and a nurse case manager for the allergy service. The factors that contributed to barriers to penicillin allergy evaluation and de-labeling were classified under six TDF domains; knowledge, skills, beliefs about capabilities, beliefs about consequences, professional role and identity, and environmental context and resources. Participants from all groups acknowledged the importance of penicillin de-labeling. However, they lacked confidence in their skills to perform the necessary evaluations, such as test dose challenges. The fear of inducing an allergic reaction and adding further complexity to patient care exacerbated their reluctance to de-label patients. The lack of ownership of de-labeling initiative was another significant obstacle in establishing consistent clinical workflows. Additionally, heavy workloads, competing priorities, and ease of access to alternative antibiotics prevented the prioritization of tasks related to de-labeling. Space limitations and nursing staff shortages added to challenges in outpatient settings. Our findings demonstrated that barriers to penicillin allergy de-labeling fall under multiple behavioral domains. Better role clarification, opportunities to develop necessary skills, and dedicated resources are needed to overcome these barriers. Future interventions will need to employ a systemic approach that addresses each of the behavioral domains influencing penicillin allergy de-labeling with stakeholder engagement of the inpatient and outpatient health care teams. The online version contains supplementary material available at 10.1186/s13223-023-00842-y.
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DOI：
10.1016/j.jcjq.2021.12.001
发表时间：
2022-03
影响因子：
2.3
作者：
Berger RE;Singh HK;Loo AS;Cooley V;Osorio SN;Lee JI;Simon MS
通讯作者：
Simon MS
影响因子：
3.7
作者：
Blumenthal KG;Shenoy ES;Huang M;Kuhlen JL;Ware WA;Parker RA;Walensky RP
通讯作者：
Walensky RP
DOI：
10.1111/j.1464-0597.2008.00341.x
发表时间：
2008-10-01
影响因子：
7.2
作者：
Michie, Susan;Johnston, Marie;Eccles, Martin
通讯作者：
Eccles, Martin
影响因子：
5.4
作者：
Davidoff F;Dixon-Woods M;Leviton L;Michie S
通讯作者：
Michie S
DOI：
10.1186/s13223-022-00659-1
发表时间：
2022-03-22
期刊：
Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology
影响因子：
--
作者：
Schrüfer P;Stoevesandt J;Trautmann A
通讯作者：
Trautmann A