The long-term sustainability of a pharmacist-led antimicrobial stewardship penicillin allergy delabelling ward round: A prospective cohort study
Bibliographic record
Abstract
Objectives Inpatient penicillin allergy is associated with inappropriate antibiotic prescribing and adverse patient outcomes. We reviewed the long-term effectiveness, safety and antimicrobial stewardship impacts of a pharmacist-led penicillin allergy delabelling ward round. Methods Adult inpatients with a penicillin allergy label were evaluated during a pharmacist-led penicillin allergy ward round implemented within a tertiary referral health service in Melbourne, Australia for more than three years. Using the validated Antibiotic Allergy Assessment Tool (AAAT) and PEN-FAST clinical decision rule, patients with a low-risk penicillin allergy or PEN-FAST score <3, were offered a single-dose direct oral challenge. Inpatient antimicrobial prescribing was reviewed pre-allergy assessment, post-delabelling, and three months post-discharge. Results Between 21 January 2019 and 24 August 2022, 477 inpatients were reviewed. Direct oral challenge was effective, with 158/166 (95.2%) low-risk inpatients delabelled. One hundred eleven (23.2%) patients had a non-immune mediated penicillin allergy label and were directly delabelled. No serious adverse events occurred. Penicillin prescribing was increased during the index admission (OR 12.06, 95% CI [5.10–28.47]) and at three months post-intervention (OR 16.45, 95% CI [3.90–69.30]) for delabelled patients, compared with those not delabelled. Conclusions Inpatient penicillin allergy delabelling was deemed effective, safe and sustainable in a pharmacist-led program, with improved inpatient antimicrobial prescribing during the index admission and following discharge.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".