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Table 2 Overview of institution-specific de-labelling programs

From: Penicillin de-labelling in vancouver, British Columbia, Canada: comparison of approaches, outcomes and future directions

 

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