Description of the combined evidence-based, theory-based and person-based approaches used to develop a behavioural intervention package to support non-allergist healthcare workers to remove incorrect penicillin allergy records from medical and surgical adult inpatients in a UK hospital Article Swipe
Neil Powell
,
Mathew Upton
,
Bridie Kent
,
Jonathan Sandoe
,
Sarah Tonkin‐Crine
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1136/bmjopen-2024-096452
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1136/bmjopen-2024-096452
Objectives To develop a behavioural intervention package to support non-allergist healthcare workers (HCWs) to remove incorrect penA records from medical and surgical adult inpatients. This paper describes the development of the penicillin allergy de-labelling (PADL) intervention and the implementation intervention that will support non-allergist-delivered PADL. Design We combined evidence-based, theory-based and person-based approaches. Qualitative research with healthcare professionals and patients explored barriers and enablers to implementation of the proposed PADL pathway. Key intervention design objectives and the key features of the implementation intervention required to achieve each objective were then developed and captured as guiding principles. We produced a logic model, integrating the theoretical domains framework to identify the behavioural influences on PADL and the behaviour change wheel to show how the implementation intervention is hypothesised to address the target behaviours. The implementation intervention package was then reviewed by stakeholders and topic experts for further refinement and optimisation. Finally, we outline how the implementation intervention will be evaluated. Setting Single-centre District General Hospital in the SW England servicing a rural community of 575 000 people without local allergy services. Results HCWs reported PADL needed to be structured, standardised, evidence based and supported by hospital approved guidelines with easy to access patient information leaflets, supported by a sustained programme of education and training with named PADL leaders and visible PADL champions. Patients wanted a good explanation of the benefits and risks of testing and the benefits of having their ‘penA’ record removed. The identified HCW target behaviours were: taking a penA allergy focused history and to risk assess the patient’s penA history; to then either de-label the patient on history alone (direct de-label; DDL) or prescribe a direct oral challenge (DOC) dose; to perform baseline and post-test observations and counsel the patient on the risks of penA records and on the risks and the benefits of PADL. We identified barriers to target behaviours that we considered both important and modifiable, which included: lack of confidence in taking a penA focused history, PADL not viewed as a priority, low confidence with differentiating low-risk and high-risk penA histories, concerns about the safety of DOC, a requirement for senior support for nurses to deliver the observations and senior support for the other HCWs to deliver PADL, access to an expert for advice when required, a lack of PADL champions to promote PADL, and PADL not being supported by the organisation. The identified patient target behaviours were acceptance of the opportunity to be de-labelled via either DDL or DOC and willingness to take penicillin when prescribed. We developed intervention components to target the HCW and patient target behaviours which included: Education, expert advice made available from Infection specialists, a named PADL champion, hospital endorsed PADL guideline with necessary tools to enable PADL and patient information leaflets. The implementation intervention was further optimised through workshops with PADL researchers and stakeholders. The Consolidated Framework for Implementation Research outcome addendum was used to define both implementation intervention and PADL intervention outcomes. Conclusions We have developed a theory-based and stakeholder-developed implementation intervention to support inpatient PADL delivered by a multiprofession workforce. The intervention will be tested in a single hospital and scalability explored.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1136/bmjopen-2024-096452
- OA Status
- gold
- Cited By
- 4
- References
- 37
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4412756419
All OpenAlex metadata
Raw OpenAlex JSON
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https://openalex.org/W4412756419Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1136/bmjopen-2024-096452Digital Object Identifier
- Title
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Description of the combined evidence-based, theory-based and person-based approaches used to develop a behavioural intervention package to support non-allergist healthcare workers to remove incorrect penicillin allergy records from medical and surgical adult inpatients in a UK hospitalWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2025Year of publication
- Publication date
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2025-07-01Full publication date if available
- Authors
-
Neil Powell, Mathew Upton, Bridie Kent, Jonathan Sandoe, Sarah Tonkin‐CrineList of authors in order
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https://doi.org/10.1136/bmjopen-2024-096452Publisher landing page
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YesWhether a free full text is available
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goldOpen access status per OpenAlex
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https://doi.org/10.1136/bmjopen-2024-096452Direct OA link when available
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Intervention (counseling), Medicine, Health care, Intervention mapping, Nursing, Medical record, Public health, Medical emergency, Family medicine, Health promotion, Surgery, Economics, Economic growthTop concepts (fields/topics) attached by OpenAlex
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4Total citation count in OpenAlex
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2025: 4Per-year citation counts (last 5 years)
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10Other works algorithmically related by OpenAlex
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