Online Antibiotic Allergy Decision Support Tool Improves Management of Beta Lactam Allergies

Frontline providers frequently make time-sensitive antibiotic choices, but many feel poorly equipped to handle antibiotic allergies. We hypothesized that a web-based decision support tool could improve antibiotic selection and confidence when managing antibiotic allergies. An online decision support tool was designed in REDCap to guide non-allergists on antibiotic challenge versus avoidance or Allergy consultation when giving beta lactams to patients with antibiotic allergy labels. 102 residents, fellows, pharmacists, and attendings chose actions for six clinical vignettes with and without the tool. Paired t-tests were used to compare actions with and without the tool. Participants completed surveys assessing their knowledge and confidence in handling allergies. Use of the tool increased the proportion of correct answers for the clinical vignettes by 63%, from 0.41 to 0.67, a difference of 0.26 (95% CI: 0.22-0.30, p<0.0001). With the tool compared to without, participants were more likely to do antibiotic challenges in low-risk situations and more likely to avoid the antibiotic or consult Allergy in high-risk situations. 96% of participants reported using the tool would increase their confidence when choosing an antibiotic for a patient with an allergy, and 95% would use the tool in their practice. A point-of-care antibiotic allergy decision support tool on a widely available platform can provide allergist-designed guidance to non-allergists and is a scalable system for addressing antibiotic allergies. This tool appropriately encouraged preferred antibiotic use in low- and medium-risk situations and increased caution in high-risk situations. It also improved provider confidence in handling antibiotic allergies.