995. A quality improvement initiative to increase penicillin allergy clarification and decrease aztreonam usage

BACKGROUND: Penicillin (PCN) allergy is a serious adverse reaction that prevents the use of first-line therapy. 10% of the population reports a PCN allergy; however, less than 1% is truly allergic. Elimination of false allergies significantly impacts patient’s lives and decreases antimicrobial resistance and cost. Inova Mount Vernon Hospital (IMVH) has reported lack of pharmacist’s interventions in allergy clarification and counseling thus leading to an increase in aztreonam usage. The primary objective of the study was to increase pharmacist’s interventions in patient allergy clarification and counseling. The secondary objective was to decrease aztreonam duration of therapy (DOT) by 10%. METHODS: This project was conducted and monitored M-F on the pharmacy true north board March-December 2018. The initial step was to create a standard work and educate pharmacists on individualized PCN allergy patients interviewing and counseling. Pharmacist’s interventions tracking were made using the electronic reporting system. To quantify aztreonam usage, duration of therapy (DOT/1000) was collected during the study period and compared with data from 2017. RESULTS: During the study implementation, a total of 551 interventions pertaining to PCN allergy were documented by pharmacists between March-November 2018, compared with only 72 interventions made in March-November 2017 (7x increase, P < 0.005). Pharmacists while intervening clarified the allergy added the severity of the reaction, documented whether patients recently tolerated any PCN-based antibiotics, and de-labeled patients when appropriate. Allergy assessments lead to a decrease in aztreonam DOT/1000 by 12% in 2018 compared with 2017 and the overall antimicrobial stewardship goal was achieved. CONCLUSION: Pharmacists interventions in allergy clarification helped with antibiotic de-escalation, improved safety, and de-labeled patients when appropriate. This initiative also increased physician and nursing awareness of the importance of clarifying PCN allergies. After successfully hardwiring this practice the pharmacy is partnering with nursing to implement PCN skin testing service at IMVH. DISCLOSURES: All authors: No reported disclosures.