{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T12:39:32Z","timestamp":1770467972977,"version":"3.49.0"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","issue":"04","funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["T32 AI106688"],"award-info":[{"award-number":["T32 AI106688"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Approximately 10% of patients have a documented penicillin \u201callergy\u201d; however, up to 95% have subsequent negative testing. These patients may receive suboptimal antibiotics, leading to longer hospitalizations and higher costs, rates of resistant and nosocomial infections, and all-cause mortality. To mitigate these risks in children, we implemented an inpatient penicillin allergy delabeling protocol and integrated it into the electronic health record (EHR) through a mixed methods approach of clinical decision support (CDS).<\/jats:p><jats:p>We describe our protocol implementation across three sequential phases: \u201cPilot,\u201d \u201cActive Antimicrobial Stewardship Program (ASP),\u201d and \u201cMixed CDS.\u201d We highlight several potential pitfalls that may have contributed to poor clinician adoption.<\/jats:p><jats:p>Patients were risk-stratified as nonallergic, low-risk, or high-risk based on history. Process measures included: evaluation rate, oral challenge rate for low-risk, and allergy referral rate for high- or low-risk when oral challenge was deferred. The primary outcome measure was the penicillin allergy delabeling rate among low-risk or nonallergic. Balancing measures included the rate of epinephrine or antihistamine administrations.<\/jats:p><jats:p>The pilot and ASP phases used clinician education and an order set, but were mostly manual processes. The mixed CDS phase introduced interruptive alerts, dynamic text in note templates, and patient list columns to guide clinicians, but little education was provided. The mixed CDS phase had the lowest evaluation rate compared with the pilot and active ASP phases (6.4 vs. 25 vs. 15%). However, when the evaluation was performed, the mixed CDS phase had the highest oral challenge rate (33 vs. 26 vs. 13%) and delabeling rate (43 vs. 33 vs. 27%). No adverse events occurred.<\/jats:p><jats:p>CDS tools improve clinician decision-making and optimize patient care. However, relying on CDS for complex clinical evaluations can lead to failure when clinicians cannot find the tool or appreciate its importance. Person-to-person communication can be vital in establishing a process and educating intended users for successful CDS implementation.<\/jats:p>","DOI":"10.1055\/a-2595-4849","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T18:55:04Z","timestamp":1745866504000},"page":"1095-1103","source":"Crossref","is-referenced-by-count":1,"title":["A Rash Decision: Implementing an EHR-Integrated Penicillin Allergy Delabeling Protocol without Adequate Clinician Support"],"prefix":"10.1055","volume":"16","author":[{"given":"Alexander S.","family":"Plattner","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, Washington University in St. Louis School of Medicine, St Louis, Missouri, United States"},{"name":"Washington University in St. Louis School of Medicine, Institute for Informatics, Data Science, and Biostatistics (I2DB), St Louis, Missouri, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine R.","family":"Lockowitz","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, St. Louis Children's Hospital, St Louis, Missouri, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca G.","family":"Same","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States"},{"name":"University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Abdelnour","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, Washington University in St. Louis School of Medicine, St Louis, Missouri, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Chin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Washington University in St. Louis School of Medicine, St Louis, Missouri, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew J.","family":"Cormier","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Washington University in St. Louis School of Medicine, St Louis, Missouri, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan S.","family":"Daugherty","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Washington University in St. Louis School of Medicine, St Louis, Missouri, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra E.","family":"Grier","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Washington University in St. Louis School of Medicine, St Louis, Missouri, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas B.","family":"Hampton","sequence":"additional","affiliation":[{"name":"BJC HealthCare, Business Intelligence Data Solutions, St Louis, Missouri, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mackenzie R.","family":"Hofford","sequence":"additional","affiliation":[{"name":"Washington University in St. Louis School of Medicine, Institute for Informatics, Data Science, and Biostatistics (I2DB), St Louis, Missouri, United States"},{"name":"Department of General Medicine and Geriatrics, Washington University in St. Louis School of Medicine, St Louis, Missouri, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah S.","family":"Mehta","sequence":"additional","affiliation":[{"name":"Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University in St. Louis School of Medicine, St Louis, Missouri, United States"},{"name":"Division of Rheumatology and Immunology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St Louis, Missouri, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason G.","family":"Newland","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin S.","family":"O'Bryan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Washington University in St. Louis School of Medicine, St Louis, Missouri, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew M.","family":"Sattler","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, Washington University in St. Louis School of Medicine, St Louis, Missouri, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehr Z.","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University in St. Louis School of Medicine, St Louis, Missouri, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G Lucas","family":"Starnes","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, Washington University in St. Louis School of Medicine, St Louis, Missouri, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerie","family":"Yuenger","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, St. Louis Children's Hospital, St Louis, Missouri, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alysa G.","family":"Ellis","sequence":"additional","affiliation":[{"name":"Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University in St. Louis School of Medicine, St Louis, Missouri, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evan E.","family":"Facer","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics, Washington University in St. Louis School of Medicine, St Louis, Missouri, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,9,12]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1001\/jama.2018.19283","article-title":"Evaluation and management of penicillin allergy: a review","volume":"321","author":"E S Shenoy","year":"2019","journal-title":"JAMA"},{"issue":"09","key":"ref2","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1111\/all.13168","article-title":"Clinical outcomes following inpatient penicillin allergy testing: a 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