Development of a complex intervention for pre-operative de-labelling of penicillin allergy

About one in eight people undergoing surgery are identified as penicillin allergic, but most of these labels are assigned due to simple side effects or family histories of issues with penicillin. When tested, over 95% of these individuals can tolerate penicillin without any problems. The problem arises when patients labelled as penicillin allergic are given alternative antibiotics. This leads to avoidable harm, including a higher risk of infections and prolonged hospital stays. This not only results in significantly increased healthcare costs but also contributes to the global issue of antimicrobial resistance. In the UK's National Health Service (NHS), approximately 7.5 million patients are currently waiting for elective surgery. It is estimated that 900,000 are labelled as penicillin allergic and at risk of unnecessary harm, such as a 50% higher chance of wound infections. It's essential to conduct allergy testing for these surgical patients before their operation, to ensure the best possible outcomes. However, the current pathway for allergy testing poses difficulties. It is time-consuming, expensive, and requires allergy specialists. With fewer than 140 specialists in the UK, testing everyone using the existing model is impossible. Efforts have been made to develop new testing pathways, involving non-allergists using decision-making tools to determine who can safely be delabelled. These initiatives show promise, with up to 65% of patients potentially able to be tested in this way. However, a recent study found several barriers to implementing this in routine NHS care, such as low uptake in specific patient groups and safety concerns among users. Further research is needed to address these challenges. Working with patients and staff, we aim to develop a pathway which is user-friendly, effective, and ready to be rolled out across the UK.