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Penicillin Allergy Evaluation and Delabeling in Nursing Homes: An Implementation Science-Guided, Multi-stakeholder Qualitative Study

Year: 2026

Type: article

Abstract: Background: Penicillin allergy labels (PALs) are common and often inaccurate, contributing to suboptimal antibiotic prescribing and adverse outcomes. These challenges are particularly pronounced in nursing homes (NH), where PAL prevalence and antibiotic exposure are high, yet penicillin allergy evaluation and delabeling are rarely implemented and stakeholder perspectives are poorly understood. We sought to identify barriers and facilitators to implementing penicillin allergy evaluation and delabeling in NH, incorporating resident, caregiver, and healthcare professional (HCP) perspectives. Methods: Between July and December 2025, we conducted semi-structured interviews with NH residents, a caregiver, and HCPs across 5 Massachusetts facilities. Interview guides were informed by the updated Consolidated Framework for Implementation Research. Data were analyzed using rapid thematic analysis with a structured matrix approach. Results: Twenty-five participants (13 residents, 1 caregiver, 11 HCPs) were included. Five cross-cutting themes emerged: (1) PALs persist unquestioned, (2) skepticism about labels coexists with reluctance to delabel, (3) structural barriers are decisive, (4) feasibility is facility- and method-specific, and (5) education and trust enable engagement, but receptiveness cannot be assumed. HCPs cited residents' cognitive impairment as a barrier, yet 13 of 21 residents screened could provide meaningful histories and participate in decision-making. History-based assessment was considered most feasible, whereas views on direct oral challenge and skin testing were divided. Conclusions: Many NH residents can engage in penicillin allergy evaluation; capacity should be assessed individually. Implementation is constrained primarily by structural barriers rather than lack of interest. Low-resource, history-based, trust-building strategies may support adoption in NH.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofag693

Authors: Kap Sum Foong, Amy M LeClair, Majd Alsoubani, Shira Doron, Alysse G Wurcel

Institutions: Tufts Medical Center, Denver Health Medical Center, AdventHealth Orlando, Boston Medical Center

Language: English

Topic: Health Policy Implementation Science

Subfield: General Health Professions

Field: Health Professions

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $4,053