Enhancing Knowledge and Attitudes Towards Penicillin Allergy Labels and Amoxicillin Challenges

Abstract

Background: Nearly 15 percent of hospitalized patients report a penicillin allergy; however, 90 percent are not truly allergic (Patterson & Stankewicz, 2023). Inaccurate penicillin allergies are associated with second-line antibiotic selection, prolonged hospitalization, and adverse patient outcomes (Powell et al., 2022). Oral amoxicillin challenges are proven to be an extremely safe and effective way to de-label inaccurate low-risk penicillin allergies (Providencia et al., 2024). Nurses are essential stakeholders and should be involved in patient allergy assessment and education (Hoffman et al., 2025). Purpose: This DNP project aimed to educate inpatient nurses on allergic reactions, penicillin allergy delabeling, and oral amoxicillin challenges. This project also aims to evaluate and improve nursing knowledge and attitudes towards allergy assessments and amoxicillin challenges to guide further nursing education, hospital-wide. This QI project was developed to prepare nurses and nurse educators for the upcoming nurse protocol change, which prompts bedside nurses to ask their patients further questions about penicillin allergy symptoms. Methods: The Institute for Healthcare Improvement (IHI) Model for Improvement was utilized as a framework to implement the project in the clinical setting. This model consists of the three fundamental questions and the Plan-Do-Study-Act (PDSA) cycle (Frankel et al., 2017). Pre and post-education session surveys were created to gather data from inpatient nurses who participate in the education session. Results: This DNP project utilized descriptive statistics to calculate t-tests and p-values to assess for statistical significance of the quantitative data (Jones et al., 2021). The education session yielded a 16.8% increase in pre- and post-survey scores with a statistically significant p-value of less than 0.05. The feedback and insights from the open-ended survey questions were summarized and presented to the nurse protocol workgroup to guide further education. Conclusions: The results of this DNP project confirmed the need for nursing education on penicillin allergy topics before the hospital-wide launch of the nurse protocol. Likewise, the project demonstrated the benefit of a formal education session in increasing nursing knowledge and attitudes toward these topics.