Hospitals adopt decision support tool to improve inpatient antibiotic use
Partners HealthCare System is leveraging an internally developed decision support tool used to determine whether patients with a penicillin allergy in their medical record could safely receive penicillin-related antibiotics.
The application, which awaits further testing and integration into hospitals’ workflow, could potentially benefit other provider organizations that could use it to give patients better drug treatment.
Those with a true allergy to the antibiotic “is less than 5 percent of those that have it on their record,” says Kimberly Blumenthal, MD, a practicing allergist at Massachusetts General Hospital (MGH) and an instructor in the Division of Rheumatology, Allergy and Immunology and the Medical Practice Evaluation Center.
While 10 percent to 15 percent of hospitalized patients have a penicillin allergy noted in their medical record, studies have shown that more than 95 percent are not really allergic, according to Blumenthal. The problem, she contends, is that this over-reporting of penicillin allergies is negatively impacting patient care, because alternative antibiotics are often less effective, more toxic and can make patients more susceptible to C. difficile infection, as well as antibiotic resistance.
According to the Centers for Disease Control and Prevention, about 2 million Americans become infected with bacteria that are resistant to antibiotics each year, and of those, 23,000 Americans die annually from these infections.
To address the problem, a decision support tool developed by Blumenthal through an MGH innovation grant is helping physicians at Partners HealthCare confirm whether a recorded penicillin allergy is real.
“This digital tool directly helps the superbug problem,” contends Blumenthal. “Based on who you are and what resistance you have, you always want to have the most narrow therapy—and, that’s often the penicillin drugs.”
The tool, accessible via a secure smartphone app or desktop computer, so far has been adopted by Partners HealthCare’s MGH, Brigham and Women’s Hospital (BWH), Newton-Wellesley Hospital, Brigham and Women's Faulkner Hospital and North Shore Medical Center.
“Skin testing has actually been around for penicillin allergies since 1960,” adds Blumenthal. “But it’s never been used with any great frequency in the hospital setting.”
However, Blumenthal believes that the Partners HealthCare decision support tool could be useful for hospitals with limited ability to adopt a skin testing protocol or that lack access to staff allergy specialists. She says the tool is remarkably accurate and calls it “the gold standard—it’s developed by allergists—and is like an allergy consultation in an app.”
In a study recently published online in the Journal of Allergy and Clinical Immunology, MGH and BWH researchers tested the use of penicillin allergy skin tests and the MGH-developed tool with inpatients at their respective facilities, and found that both approaches safely increased the use of penicillin and penicillin-related antibiotics.
“Both the computerized guideline with decision support and penicillin skin testing—when completed—increased use of penicillin and cephalosporin antibiotics among inpatients reporting penicillin allergy,” concludes the study. “While the skin tested subset showed an almost six-fold impact, the computerized guideline significantly increased penicillin or cephalosporin use overall nearly two-fold and was readily implemented.”
Going forward, Blumenthal says that a year-long study will be conducted to evaluate the tool’s impact at all five of the Partners HealthCare hospitals currently using the decision support tool.
At the same time, Blumenthal acknowledges that one of the limitations of the tool and its “mobile-friendly website” is that it has not been completely integrated into Partners HealthCare’s new Epic electronic health record system.
“The next step for us is to figure out how to integrate it better with the Epic EHR and make it available to other hospitals, because this is a problem that every hospital is facing and we need a good scalable solution,” she says.