A Multidisciplinary Quality Improvement Initiative to Facilitate Penicillin Allergy Delabeling Among Hospitalized Pediatric Patients.

BACKGROUND: Penicillin allergy is reported in up to 10% of the general population; however, >90% of patients reporting an allergy are tolerant. Patients labeled as penicillin allergic have longer hospital stays, increased exposure to suboptimal antibiotics, and an increased risk of methicillin-resistant Staphylococcus aureus and Clostridioides difficile. The primary aim with our quality improvement initiative was to increase penicillin allergy delabeling to at least 10% among all hospitalized pediatric patients reporting a penicillin allergy with efforts directed toward patients determined to be low risk for true allergic reaction. METHODS: Our quality improvement project included several interventions: the development of a multidisciplinary clinical care pathway to identify eligible patients, workflow optimization to support delabeling, an educational intervention, and participation in our institution's quality improvement incentive program. Our interventions were targeted to facilitate appropriate delabeling by the primary hospital medicine team. Statistical process control charts were used to assess the impact of this intervention pre- and postpathway implementation. RESULTS: After implementation of the clinical pathway, the percentage of patients admitted to hospital medicine delabeled of their penicillin allergy by discharge increased to 11.7%. More than one-half of those delabeled (51.2%) received a penicillin-based antimicrobial at time of discharge. There have been no adverse events or allergic reactions requiring emergency medication administration since pathway implementation. CONCLUSIONS: Our quality improvement initiative successfully increased the rate of penicillin allergy delabeling among low-risk hospitalized pediatric patients, allowing for increased use of optimal antibiotics.

The Atopic Dermatitis Quickscore (ADQ): validation of a new parent-administered atopic dermatitis scoring tool.

BACKGROUND: Atopic dermatitis (AD) severity is assessed using relatively elaborate scoring systems administered by health care practitioners; modification for parent assessment or self-assessment is limited. For ongoing home-based evaluation of pediatric AD treatment and outcomes, a quick, easy-to-use, parent-administered scoring tool is essential. OBJECTIVE: To evaluate the validity and responsiveness to change of the Atopic Dermatitis Quickscore (ADQ) compared with the established, widely used Scoring Atopic Dermatitis Severity Index (SCORAD). METHODS: The ADQ was developed for parent report and was validated against the SCORAD. The SCORAD assesses percentage of body surface area involved, intensity of a "representative area," pruritus, and insomnia. The ADQ assesses involvement and pruritus of 7 body parts. Sixty-eight children entering a pediatric day treatment program for moderate to severe AD were recruited. Skin severity was scored at admission by a physician assistant using the SCORAD and by a parent using the ADQ. Pearson correlations of the 2 scales were assessed. RESULTS: The ADQ total score correlates with the SCORAD total score (r = 0.64, P < .001). The ADQ pruritus score correlates with the SCORAD pruritus score (r = 0.62, P < .001). Correlation at the end of treatment was also seen for ADQ and SCORAD total and pruritus scores (r = 0.39, P = .02, and r = 0.66, P < .001, respectively). Responsiveness of both scales to change in skin condition was demonstrated, with significant decreases in total and pruritus scores (P < .001). CONCLUSIONS: The parent-administered ADQ takes 5 minutes to complete. Scores from the ADQ and the SCORAD are well correlated and are responsive to changes in skin condition, supporting the validity of the ADQ.