Digital Antibiotic Allergy Decision Support Tool Improves Management of b-Lactam Allergies

BACKGROUND: Frontline providers frequently make time -sensitive antibiotic choices, but many feel poorly equipped to handle antibiotic allergies. OBJECTIVE: We hypothesized that a digital decision support tool could improve antibiotic selection and confidence when managing b-lactam allergies. METHODS: A digital decision support tool was designed to guide non-allergist providers in managing patients with b-lac -tam allergy labels. Non-allergists were asked to make decisions in clinical test cases without the tool, and then with it. These de-cisions were compared using paired t tests. Users also completed surveys assessing their confidence in managing antibiotic allergies. RESULTS: The tool's algorithm was validated by confirming its recommendations aligned with that of five allergists. Non-allergist providers (n [ 102) made antibiotic management decisions in test cases, both with and without the tool. Use of the tool increased the proportion of correct decisions from 0.41 to 0.67, a difference of 0.26 (95% CI, 0.22-0.30; P < .001). Users were more likely to give full-dose antibiotics in low-risk situations, give challenge doses in medium-risk situations, and avoid the antibiotic and/or con-sult allergy departments in high-risk situations. A total of 98 users (96%) said the tool would increase their confidence when choosing antibiotics for patients with allergies. CONCLUSIONS: A point-of-care clinical decision tool provides allergist-designed guidance for non-allergists and is a scalable system for addressing antibiotic allergies, irrespective of allergist availability. This tool encouraged appropriate antibiotic use in low-and medium-risk situations and increased caution in high -risk situations. A digital support tool should be considered in quality improvement and antibiotic stewardship efforts. (c) 2023 American Academy of Allergy, Asthma & Immunology (J Allergy Clin Immunol Pract 2023;11:1243-52)

Automated summary

A digital decision support tool was found to improve antibiotic selection and increase confidence in managing b-lactam allergies among non-allergist providers.