Implementation and performance of a nurse administered modified PEN-FAST clinical decision rule in the electronic health record
Abstract Objective: To evaluate performance of registered nurse assessments of the PEN-FAST penicillin allergy clinical decision rule compared to antimicrobial stewardship pharmacists. Design: Prospective, blinded, non-interventional, quality assurance study. Setting: This study took place acr...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2025-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X25100661/type/journal_article |
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| author | Wesley J. Hoffmann Shivani Patel Elizabeth J. Lee Natalie A. Finch Christy P. Su Nicole A. Teran Yao-Hsuan Huang Fadi Shehadeh Muhammad Yasser Alsafadi |
| author_facet | Wesley J. Hoffmann Shivani Patel Elizabeth J. Lee Natalie A. Finch Christy P. Su Nicole A. Teran Yao-Hsuan Huang Fadi Shehadeh Muhammad Yasser Alsafadi |
| author_sort | Wesley J. Hoffmann |
| collection | DOAJ |
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Abstract
Objective:
To evaluate performance of registered nurse assessments of the PEN-FAST penicillin allergy clinical decision rule compared to antimicrobial stewardship pharmacists.
Design:
Prospective, blinded, non-interventional, quality assurance study.
Setting:
This study took place across 4 inpatient hospitals within a large health system in Houston, Texas.
Methods:
We implemented PEN-FAST rule questions into the electronic health record (EHR) for registered nurses to perform. Patients were randomly selected in a prospective fashion, with nurse documented scores hidden, for re-assessment by antimicrobial stewardship pharmacists to compare risk stratification and scores.
Results:
Overall agreement of high risk and low risk results was 84.3%. Registered nurse evaluations with the PEN-FAST clinical decision rule for detecting a high-risk patient demonstrated a sensitivity of 67%, specificity of 89.8%, positive predictive value of 67.9%, and negative predictive value of 89.5%. Additionally, 34.4% of patients with a documented penicillin allergy admitted to tolerating amoxicillin or amoxicillin/clavulanate since their last recalled reaction to penicillin.
Conclusions:
Registered nurse assessment of the PEN-FAST clinical decision rule demonstrated good performance and can effectively be used to screen for low-risk penicillin allergy patients. Incorporation of the PEN-FAST rule into EHR can be scaled into large health systems to help appropriately stratify patients with low- and high-risk penicillin allergies and improve documentation.
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| format | Article |
| id | doaj-art-bcbd88cca7624f81bd46b19cdaa192a2 |
| institution | Matheson Library |
| issn | 2732-494X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj-art-bcbd88cca7624f81bd46b19cdaa192a22025-07-18T11:38:15ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2025-01-01510.1017/ash.2025.10066Implementation and performance of a nurse administered modified PEN-FAST clinical decision rule in the electronic health recordWesley J. Hoffmann0https://orcid.org/0000-0002-1180-021XShivani Patel1Elizabeth J. Lee2Natalie A. Finch3https://orcid.org/0009-0009-0888-5943Christy P. Su4https://orcid.org/0009-0001-9893-2847Nicole A. Teran5Yao-Hsuan Huang6https://orcid.org/0009-0008-9002-9793Fadi Shehadeh7Muhammad Yasser Alsafadi8https://orcid.org/0000-0003-0276-7910Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USADepartment of Pharmacy, Houston Methodist Hospital, Houston, TX, USADepartment of Pharmacy, Houston Methodist The Woodlands, Conroe, TX, USADepartment of Pharmacy, Houston Methodist Hospital, Houston, TX, USADepartment of Pharmacy, Houston Methodist West, Katy, TX, USADepartment of Pharmacy, Houston Methodist Willowbrook, Houston, TX, USADepartment of Pharmacy, Houston Methodist Hospital, Houston, TX, USADepartment of Medicine, Houston Methodist Hospital, Houston, TX, USA Department of Electrical Engineering and Computer Engineering, National Technical University of Athens, Athens, GreeceDivision of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, TX, USA Abstract Objective: To evaluate performance of registered nurse assessments of the PEN-FAST penicillin allergy clinical decision rule compared to antimicrobial stewardship pharmacists. Design: Prospective, blinded, non-interventional, quality assurance study. Setting: This study took place across 4 inpatient hospitals within a large health system in Houston, Texas. Methods: We implemented PEN-FAST rule questions into the electronic health record (EHR) for registered nurses to perform. Patients were randomly selected in a prospective fashion, with nurse documented scores hidden, for re-assessment by antimicrobial stewardship pharmacists to compare risk stratification and scores. Results: Overall agreement of high risk and low risk results was 84.3%. Registered nurse evaluations with the PEN-FAST clinical decision rule for detecting a high-risk patient demonstrated a sensitivity of 67%, specificity of 89.8%, positive predictive value of 67.9%, and negative predictive value of 89.5%. Additionally, 34.4% of patients with a documented penicillin allergy admitted to tolerating amoxicillin or amoxicillin/clavulanate since their last recalled reaction to penicillin. Conclusions: Registered nurse assessment of the PEN-FAST clinical decision rule demonstrated good performance and can effectively be used to screen for low-risk penicillin allergy patients. Incorporation of the PEN-FAST rule into EHR can be scaled into large health systems to help appropriately stratify patients with low- and high-risk penicillin allergies and improve documentation. https://www.cambridge.org/core/product/identifier/S2732494X25100661/type/journal_article |
| spellingShingle | Wesley J. Hoffmann Shivani Patel Elizabeth J. Lee Natalie A. Finch Christy P. Su Nicole A. Teran Yao-Hsuan Huang Fadi Shehadeh Muhammad Yasser Alsafadi Implementation and performance of a nurse administered modified PEN-FAST clinical decision rule in the electronic health record Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Implementation and performance of a nurse administered modified PEN-FAST clinical decision rule in the electronic health record |
| title_full | Implementation and performance of a nurse administered modified PEN-FAST clinical decision rule in the electronic health record |
| title_fullStr | Implementation and performance of a nurse administered modified PEN-FAST clinical decision rule in the electronic health record |
| title_full_unstemmed | Implementation and performance of a nurse administered modified PEN-FAST clinical decision rule in the electronic health record |
| title_short | Implementation and performance of a nurse administered modified PEN-FAST clinical decision rule in the electronic health record |
| title_sort | implementation and performance of a nurse administered modified pen fast clinical decision rule in the electronic health record |
| url | https://www.cambridge.org/core/product/identifier/S2732494X25100661/type/journal_article |
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