Implementation of allergy reconciliation for beta-lactam allergies
Authors: Mark Angel, PharmD; Lori Belle Slone, PharmD, BCPS; Jessica Sobnosky, PharmD, BCPS, BCIDPObjective: •Audience members will be able to apply the PEN-FAST tool during medication reconciliation to risk-stratify beta-lactam allergies.
UDIEBackground: Inaccurate beta-lactam (BL) allergy documentation limits first-line antibiotic use and promotes broad-spectrum alternatives. This study evaluates whether pharmacy led allergy reconciliation improves documentation accuracy and antimicrobial selection.Methods: This study reviewed electronic health records of patients ≥18 years with a documented beta-lactam (BL) allergy who underwent pharmacist-led allergy reconciliation between November 1, 2025, and March 1, 2026. Allergy documentation was evaluated for accuracy and clinical relevance following reconciliation. The primary outcome was the proportion of patients with updated BL allergy documentation. Secondary outcomes included the proportion of patients with antimicrobial therapy modification and BL utilization following clarification. Data were collected via retrospective chart review at study completion, de-identified, and securely stored. Descriptive statistics were used, with categorical variables such as PEN-FAST risk levels and documentation rates reported as frequencies and percentages to identify gaps between clinical reconciliation and formal documentation practices.
Results: A total of 189 patients were eligible for inclusion with 50 being randomized for analysis. Risk stratification using the PEN-FAST tool identified 14 patients (28%) as very low risk, 19 (38%) as low risk, 15 (30%) as moderate risk, and 2 (4%) as high risk. The primary outcome of updated allergy documentation was achieved in one patient (2%). Regarding secondary outcomes, no modifications to antimicrobial therapy were observed during the initial admission following reconciliation. Prior to PEN-FAST assessment, 66% of low-risk patients were already receiving BL therapy. Zero adverse drug reactions related to BLs occurred during the study period.
Conclusion: Although pharmacy-led reconciliation did not result in immediate antimicrobial therapy changes, it identified a gap between allergy risk assessment and clinical decision-making. Most patients were low or very low risk by PEN-FAST and were already receiving beta-lactams. However, improved allergy documentation provides lasting value by supporting optimized antibiotic selection in future encounters and highlights the need for better use of validated assessment tools.
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