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
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.
Methods: 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.
Results: 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.
Conclusions: 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.
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BibTeX
@article{toner2026closing,
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}},
author = {Philip Toner and Annabel Glass and Cathal Donnelly and Katherine Garnett and Mark Mchaffie and Sean Quinn and Christopher Hillen and Jonathan Mullan and Yazan H Mustafa and Connor Maguire and Sean Faulkner and Bernice Ng and Aaron Brady},
journal = {JAC-Antimicrobial Resistance},
year = {2026},
month = nov,
doi = {10.1093/jacamr/dlag244},
url = {https://doi.org/10.1093/jacamr/dlag244},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - 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
AU - Philip Toner
AU - Annabel Glass
AU - Cathal Donnelly
AU - Katherine Garnett
AU - Mark Mchaffie
AU - Sean Quinn
AU - Christopher Hillen
AU - Jonathan Mullan
AU - Yazan H Mustafa
AU - Connor Maguire
AU - Sean Faulkner
AU - Bernice Ng
AU - Aaron Brady
PY - 2026
DA - 2026/11/05
JO - JAC-Antimicrobial Resistance
DO - 10.1093/jacamr/dlag244
UR - https://doi.org/10.1093/jacamr/dlag244
AB - 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. Methods: 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. Results: 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. Conclusions: 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.
SN - 2632-1823
ER -