{
  "abstract": "Objectives: To describe and evaluate a needs-assessment informed model for embedding a non-allergist penicillin allergy de-labelling (PADL) service within an Acute Medical Unit (AMU), including stakeholder experience.\n\nMethods: A four-phase quality improvement project in one UK AMU, reported per SQUIRE 2.0. Phase 1: needs-assessment survey of 124 staff (pharmacists, doctors, nurses, immunology staff). Phase 2: a multidisciplinary team translated Phase 1 barriers into a PEN-FAST-guided direct oral amoxicillin challenge (DOC) protocol delivered by acute medicine consultants and pharmacists; design decisions were retrospectively mapped to the capability, opportunity and motivation model for behavioural change and Behaviour Change Wheel. Phase 3: DOC in 60 adult inpatients penicillin allergy labels. Phase 4: post-implementation survey of 54 patients and staff.\n\nResults: Before implementation, 90% of staff anticipated a service would be useful, but identified time, education, safety concerns and staffing as the main barriers. Fifty-nine of 60 patients (98.3%) were de-labelled, with one mild Type 4 reaction but no anaphylaxis. All 21 (35.6%) who needed antibiotics within six months received a penicillin without reported reaction. All 54 post-implementation respondents rated the service extremely useful and would recommend or refer into it; as Phase 1 and Phase 4 cohorts were non-matched, this comparison is indicative only. Patients described years of unwarranted anxiety about antibiotic use that resolved after de-labelling.\n\nConclusions: A needs-assessment-informed model translated staff-identified barriers into design decisions and was associated with high stakeholder endorsement, durable penicillin use and an under-recognized psychological benefit for patients. It offers a practical, replicable template for non-allergist PADL in acute medicine.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 13,
  "authors": [
    {
      "name": "Philip Toner",
      "orcid": "0009-0007-9421-362X"
    },
    {
      "name": "Annabel Glass"
    },
    {
      "name": "Cathal Donnelly"
    },
    {
      "name": "Katherine Garnett"
    },
    {
      "name": "Mark Mchaffie"
    },
    {
      "name": "Sean Quinn"
    },
    {
      "name": "Christopher Hillen"
    },
    {
      "name": "Jonathan Mullan"
    },
    {
      "name": "Yazan H Mustafa"
    },
    {
      "name": "Connor Maguire"
    },
    {
      "name": "Sean Faulkner"
    },
    {
      "name": "Bernice Ng"
    },
    {
      "name": "Aaron Brady"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8f6d76wbrxd99.bib",
  "cited_by": 0,
  "doi": "10.1093/jacamr/dlag244",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13736110/",
  "id": "8f6d76wbrxd99",
  "issns": [
    "2632-1823"
  ],
  "landing_url": "https://doi.org/10.1093/jacamr/dlag244",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "AcademicSubjects/MED00740"
    ],
    [
      "heading",
      "AcademicSubjects/SCI01150"
    ],
    [
      "heading",
      "Original Article"
    ],
    [
      "openalex",
      "2736|Drug-Induced Adverse Reactions"
    ]
  ],
  "openalex": "W7225301540",
  "pdf_url": "https://academic.oup.com/jacamr/article-pdf/8/6/dlag244/73100203/dlag244.pdf",
  "pmcid": "PMC13736110",
  "pmid": "42991575",
  "published": "2026-11-05",
  "publisher": "Oxford University Press",
  "ris": "https://research.draconitic.com/paper/8f6d76wbrxd99.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T12:21:38Z",
      "native_id": "PMC13736110",
      "source": "pmc",
      "url": "https://doi.org/10.1093/jacamr/dlag244"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2736|Drug-Induced Adverse Reactions",
      "subfield": "pharmacology-toxicology"
    }
  ],
  "title": "Closing the loop: a needs-assessment informed model for embedding a non-allergist penicillin allergy de-labelling service in acute medicine, a quality improvement report",
  "title_text": "Closing the loop: a needs-assessment informed model for embedding a non-allergist penicillin allergy de-labelling service in acute medicine, a quality improvement report",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T12:21:38Z",
  "url": "https://research.draconitic.com/paper/8f6d76wbrxd99",
  "venue": "JAC-Antimicrobial Resistance",
  "versions": []
}