Parent-reported penicillin allergies in children: A qualitative study.

BACKGROUND: Penicillin allergies are commonly reported in children. Most reported penicillin allergies are false, resulting in the unnecessary selection of alternative antibiotic treatments that promote antibiotic resistance. While formal allergy testing is encouraged to establish a diagnosis of penicillin allergy, children are rarely referred for allergy testing, and study of parents' experiences and perceptions of their child's reported penicillin allergy is limited. We aimed to describe parents' experiences and perceptions of their child's penicillin allergy and attitudes towards penicillin allergy testing to identify opportunities to engage parents in antimicrobial stewardship efforts. METHODS: This was a qualitative descriptive study. RESULTS: Eighteen parents participated in this study. Parents' children were on average 2 years old when the index reaction occurred, and 7 years had passed since the reaction. Transcripts revealed that participants were receptive to penicillin allergy testing for their child after learning the consequences of penicillin allergy and availability of allergy testing. Four major themes emerged from data (1) parents' making sense of allergy; (2) parents' impressions of allergy label, (3) parents' attitudes towards allergy testing, and (4) parents' desire to be informed of testing availability. CONCLUSIONS: Efforts are needed to engage parents in addressing spuriously reported penicillin allergies.

Perspectives of Clinicians at Skilled Nursing Facilities on 30-Day Hospital Readmissions: A Qualitative Study.

BACKGROUND: Unplanned 30-day hospital readmissions are an important measure of hospital quality and a focus of national regulations. Skilled nursing facilities (SNFs) play an important role in the readmission process, but few studies have examined the factors that contribute to readmissions from SNFs, leaving hospitalists and other hospital-based clinicians with limited evidence on how to reduce SNF readmissions. OBJECTIVE: To understand the perspectives of clinicians working at SNFs regarding factors contributing to readmissions. DESIGN AND PARTICIPANTS: We prospectively identified consecutive readmissions from SNFs to a single tertiary-care hospital. Index admissions and readmissions were to the hospital's inpatient general medicine service. SNF clinicians who cared for the readmitted patients were identified and interviewed about root causes of the readmissions using a structured interview tool. Transcripts of the interviews were inductively analyzed using grounded theory methodology. RESULTS: RESULTS: We interviewed 28 clinicians at 15 SNFs. The interviews covered 24 patient readmissions. SNF clinicians described a range of procedural, technological, and cultural contributors to unplanned readmissions. Commonly cited causes of readmission included a lack of coordination between emergency departments and SNFs, poorly defined goals of care at the time of hospital discharge, acute illness at the time of hospital discharge, limited information sharing between a SNF and hospital, and SNF process and cultural factors. CONCLUSIONS: SNF clinicians identified a broad range of factors that contribute to readmissions. Addressing these factors may mitigate patients' risk of readmission from SNFs to acute care hospitals.

Benchmarking a Home-Delivered Meal Program's Annual Satisfaction Survey: A Metropolitan Area Neighborhood Nutrition Alliance (MANNA) Initiative in Philadelphia.

The Metropolitan Area Neighborhood Nutrition Alliance (MANNA) is a community-based organization providing home-delivered meals in Philadelphia, Pennsylvania to individuals at acute nutritional risk and experiencing a life-threatening illness, independent of age or income. The challenge MANNA faces, like other community-based organizations, is to demonstrate effective services by benchmarking with other organizations. This article reports how MANNA benchmarked results of their annual satisfaction survey against the 2013 National Survey of Older Americans Act Program. Overall, MANNA recipients were more often satisfied with the taste and variety of food, and more MANNA recipients rated the program as excellent. However, more MANNA recipients reported not having enough money to buy food, skipping meals because of money, needing to choose between food and medications or food and utilities. MANNA is using these findings as an impetus to better understand the needs of their clients, especially as they transition off the meal program, and to identify additional resources to support transitional programming.