Implementing a Perioperative Penicillin Allergy De-labelling Service (IPPADS)

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Implementing a Perioperative Penicillin Allergy De-labelling Service (IPPADS)

Thank you for completing our short questionnaire.

We are studying factors affecting whether anaesthetists would be willing to give penicillin to elective surgical patients who have had a penicillin allergy record removed in Pre-Assessment Clinic. We would be grateful for your help. The questionnaire is short and will only take a few minutes of your time.

No personally identifiable data is requested. By completing the questionnaire you are consenting to your response being used in data analysis and publication.

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What is your role? *

Consultant

Specialty and Associate Specialist (SAS)

Higher Specialty Trainee/"Registrar"

Core Trainee/"Senior House Officer"

Other

If you selected 'Other' - please describe your role

Which hospital do you currently work at? *

Royal Cornwall Hospitals NHS Trust (Truro)

University Hospitals Plymouth NHS Trust (Derriford, Plymouth)

Royal Devon and Exeter NHS Trust (Exeter)

Torbay and South Devon NHS Trust (Torbay)

North Devon Healthcare NHS Trust (Barnstaple)

Musgrove Park Hospital NHS Trust (Taunton)

Part One

Case Scenario:

You are asked to anaesthetise a patient for elective surgery. They previously had a label of penicillin allergy, but this label has been removed (de-labelled) during their routine pre-operative preparation by the team at pre-assessment clinic, using a process approved by the regional allergy and immunology department, and documented in the notes. This process involved an initial screening questionnaire, which from the clinical features classified them as low risk of reaction on future exposure. They were then given a single dose of oral penicillin which they tolerated without reaction. You have now been asked to administer a dose of intravenous penicillin as part of their peri-operative antibiotic prophylaxis (rather than a non-penicillin alternative).

Following are a number of examples of two opposing statements regarding your beliefs about this scenario.

Which of these statements do you agree with more, and by how much? *

I do not have enough knowledge to give penicillin to this patient

1

2

3

4

5

I have enough knowledge to give penicillin to this patient

Which of these statements do you agree with more, and by how much? *

I do not have the required skills to manage penicillin administration to this patient

1

2

3

4

5

I have the required skills to manage penicillin administration to this patient

Which of these statements do you agree with more, and by how much? *

It is not part of my role to give penicillin in this situation

1

2

3

4

5

It is part of my role to give penicillin in this situation

Which of these statements do you agree with more, and by how much? *

I would find it difficult to give penicillin to this patient

1

2

3

4

5

I would find it easy to give penicillin to this patient

Which of these statements do you agree with more, and by how much? *

I do not believe this group of patients can successfully be de-labelled

1

2

3

4

5

I believe that this group of patients can successfully be de-labelled

Which of these statements do you agree with more, and by how much? *

I believe that giving penicillin (instead of an alternative) to this group of patients would lead to negative outcomes

1

2

3

4

5

I believe that giving penicillin (instead of an alternative) to this group of patients would lead to positive outcomes

Which of these statements do you agree with more, and by how much? *

I will not get rewarded for giving penicillin to this patient

1

2

3

4

5

I will get rewarded for giving penicillin to this patient

Which of these statements do you agree with more, and by how much? *

I do not have a goal to give penicillin to this patient

1

2

3

4

5

I have a goal to give penicillin to this patient

Which of these statements do you agree with more, and by how much? *

I would find it difficult to make the decision to give penicillin to this patient

1

2

3

4

5

I would find it easy to make the decision to give penicillin to this patient

Which of these statements do you agree with more, and by how much? *

I do not have the resources I need to give penicillin to this patient

1

2

3

4

5

I have the resources I need to give penicillin to this patient

Which of these statements do you agree with more, and by how much? *

My colleagues would have a negative opinion about giving penicillin to this patient

1

2

3

4

5

My colleagues would have a positive opinion about giving penicillin to this patient

Which of these statements do you agree with more, and by how much? *

I am worried or concerned about giving penicillin to this patient

1

2

3

4

5

I am happy and content about giving penicillin to this patient

Which of these statements do you agree with more, and by how much? *

I will not receive feedback after giving penicillin to this patient

1

2

3

4

5

I will receive feedback after giving penicillin to this patient

Which of these statements do you agree with more, and by how much? *

I do not intend to give penicillin to this group of patients in the future

1

2

3

4

5

I intend to give penicillin to this group of patients in the future

Do you have any other comments about specific barriers or enablers for you giving penicillin in this scenario?

Part 2

Reminder of Scenario:

You are asked to anaesthetise a patient for elective surgery. They previously had a label of penicillin allergy, but this label has been removed (de-labelled) during their routine pre-operative preparation by the team at pre-assessment clinic, using a process approved by the regional allergy and immunology department, and documented in the notes. This process involved an initial screening questionnaire, which from the clinical features classified them as low risk of reaction on future exposure. They were then given a single dose of oral penicillin which they tolerated without reaction. You have now been asked to administer a dose of intravenous penicillin as part of their peri-operative antibiotic prophylaxis (rather than a non-penicillin alternative).

Each statement describes a factor which may affect your behaviour in this scenario.

Please rate each factor for how important you think it is to you giving/not giving this patient penicillin.

Having enough knowledge to give penicillin to these patients *

Not important at all

1

2

3

4

5

Very important

Having the required skills to manage penicillin administration to these patients *

Not important at all

1

2

3

4

5

Very important

Whether this is a part of my role or not to give penicillin to these patients *

Not important at all

1

2

3

4

5

Very important

How difficult or easy I would find giving penicillin to these patients *

Not important at all

1

2

3

4

5

Very important

How optimistic or pessimistic I am about whether these patients can successfully be de-labelled *

Not important at all

1

2

3

4

5

Very important

Whether I think administering penicillin to these patients instead of alternative antibiotics improves or worsens patient outcomes *

Not important at all

1

2

3

4

5

Very important

Whether I am rewarded or not for giving penicillin to these patients *

Not important at all

1

2

3

4

5

Very important

Whether I have a goal to give penicillin to these patients or not *

Not important at all

1

2

3

4

5

Very important

How easy I find it to decide whether to give penicillin to these patients or not *

Not important at all

1

2

3

4

5

Very important

Whether I have the resources I need or not to give penicillin to these patients *

Not important at all

1

2

3

4

5

Very important

Whether my colleagues have a positive or negative opinion about giving penicillin to these patients *

Not important at all

1

2

3

4

5

Very important

How comfortable or concerned I am about giving penicillin to these patients *

Not important at all

1

2

3

4

5

Very important

Whether I receive feedback or not after giving penicillin to these patients *

Not important at all

1

2

3

4

5

Very important

Whether I currently intend to give penicillin to these patients or not *

Not important at all

1

2

3

4

5

Very important

Do you have any specific comments about important factors in whether you would give or not give penicillin in this scenario?

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