| St. Paul’s Hospital | Vancouver General Hospital | BC Women’s Hospital | Lion’s Gate Hospital | BC Children’s Hospital | ||
---|---|---|---|---|---|---|---|
Target Population | All inpatients and outpatients | Internal medicine patients | Leukemia and bone marrow transplant patients | Obstetric patients | Adult inpatients and outpatients | Obstetric patients | Pediatric inpatients and oncology patients |
Start Date | Inpatients April 2015; Outpatient April 2017 | July 2020 | October 2018 | July 2020 | 2018 | Sept 2020 | November 2019 |
Inpatient vs. Outpatient | Both | Inpatient | Outpatient | Outpatient | Both | Outpatient | Inpatient |
Patient Identified by | Inpatients identified through EMR by pharmacist, nurse practitioners or physicians; Outpatients referred by ID physician | Electronic Medical Record | Pharmacist or transplant nurse navigator | Referral | Inpatient or community referral | Community referral | Pharmacy screen or pediatrics team |
Patients Initially Assessed By | Pharmacist | Pharmacist | Pharmacist | Physician | Pharmacist | Pharmacist | Pharmacist |
De-label based on history? | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Risk-Stratification Tool | PEN-FAST | PEN-FAST | Algorithm adapted from the (CPS) practice point on beta-lactam allergies | PEN-FAST | Institution-specific protocol based on PACE committee | Institution-specific protocol based on PACE committee | Algorithm adapted from algorithm published in the CPS practice point on beta-lactam allergies |
Skin Testing Performed | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Skin test Performed by | Allergist | Allergist | Pharmacist or Allergist | Allergist | Medical Daycare Nurse | Medical Daycare Nurse | Allergist (approval for pharmacist pending) |
Direct Oral Challenge Performed | Yes | Yes | Yes | Yes | Yes | Yes (if passed skin test) | Yes |
Oral Challenge and DOC Performed By | Allergist or patient’s MRP | Bedside nurse | Daycare unit nurse or Allergist | Usually pharmacist but can be done by anyone on team | Inpatient challenge performed by AMS pharmacist; Outpatient challenge performed by medical daycare nurse | Medical daycare nurse | Pharmacist |
Monitoring | Bedside nurse (directed by an allergist, pharmacist or care team physician) | Bedside Nurse | Virtual (by allergist) or In-Person monitoring (by daycare nurse) | Clinic Nurse | Inpatient by AMS pharmacist and bedside nurse; Outpatient by medical daycare nurse or physician | Medical Day Care Nurse | Parent |