For over 10 years, pharmacists at Iowa Methodist Medical Center have tested patients for penicillin sensitivity. The program hasn’t always run smoothly, but it works in an effort to avoid treating with more expensive medications, and medications that often have more serious side effects.
In the program’s initial run, pharmacists evaluated 26 patients for the allergy. The skin test showed negative results in 22 of the 23 who met testing criteria. For that one patient, the skin test did not determine anything, but all 26 of those patients were treated with penicillin without experiencing any issues.
The allergy skin testing service came as a result of an Iowa state law that allows pharmacists to work collaboratively with doctors, without restriction on setting or disease. This means pharmacists can work outside of their normal scope, so long as their work is overseen by doctors, and is hospital approved.
The head of the allergy department at Iowa Methodist used to work as a pharmacist, so he taught staff how to do skin tests, and how to read them. The service then became available to infectious diseases (ID) doctors.
Though the program got a great start, the testing protocol required the use of Pre-Pen, the only product in the U.S. available for performing penicillin sensitivity skin tests. This product was withdrawn from the market in 2004. As a result, the service was put on hold.
In late 2009, the FDA approved another manufacturer to market the Pre-Pen, which allowed the hospital to resume the service in 2010. Since then, they’ve done between 30 and 40 skin tests, with only one patient producing a positive result.
Pharmacy staff is re-grouping to build a stronger program, as there is currently a limited staff that can handle the testing, and the testing is time consuming – taking up to an hour of a pharmacist’s time to complete. By October 2014, the hospital hopes to have enough pharmacists trained so the work does not fall on a single employee.
If the skin test is warranted from the pharmacist’s assessment of the patient, it is performed with guidance from the American Academy of Allergy, Asthma & Immunology under the manufacturer’s direction. From there, test results are communicated to the ID doctor.
The program is not just a penicillin skin test program – it is a drug allergy assessment service, as medical staff communicates with patients to learn as much as they can about their drug allergies.
Iowa Methodist has trained other area hospital pharmacists on performing and reading skin tests, but is not sure if any other facilities have implemented a similar program.
Some states may have laws that prevent pharmacists from administering the tests, but in states where this is not an issue, pharmacists may be able to replicate the program at their own facilities.