Penicillin allergy de-labelling implementation intervention in a UK hospital: a process evaluation, the patient experience

Background: Penicillin allergy (penA) records are common, but true penA is rare. PenA records are associated with broad spectrum antibiotic prescribing and negative patient outcomes. We developed a behavioural intervention package to support inpatient penicillin allergy de-labelling (PADL) delivered by a multi-profession non-allergist workforce to remove incorrect penA records from medical and surgical adult inpatients in a UK hospital. Aims: To explore the experiences, beliefs and concerns of patients who had been offered PADL. Methods: Semi-structured interviews to explore the views of patients admitted to a medical or surgical ward with a penA record and offered PADL between June 2024 and October 2024. Inductive reflexive thematic analysis was used to analyse the data. Results: Twenty patients were interviewed. Patients that believed their penA to be incorrect and those that described their index reaction as mild were more likely to agree to testing. Patients considered hospital a safe place to be tested. Some patients thought being acutely unwell was not a barrier to testing, whereas others preferred an outpatient setting once discharged from hospital. De-labelled patients described having a good explanation of the risks and benefits of PADL, were grateful for the opportunity and trusted the healthcare worker and the PADL process. Conclusion: PADL was well accepted by patients who described receiving a good explanation of the PADL process. Index reactions perceived as low severity (e.g. non-severe rashes) and/or doubtful of their penA (e.g. unaware they had a penA record) were more likely to accept PADL. Some who declined inpatient PADL would consider outpatient testing once recovered from their acute illness.