Reducing penicillin allergy mislabelling: A one-day structured training program improves nurses’ knowledge and self-reported confidence in allergy assessment and skin testing

Xinyu Duan, Weihong Shi, Jinxian Huang, Ligang Yang, Elaine Lee, Gabriel K.C. Leung, Mudiao Chen,
Xueyu He, Han Liu, Philip H. Li

Affiliations:
¹ Division of Rheumatology & Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
² Division of Rheumatology & Clinical Immunology, Department of Medicine, University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
³ Dermatology Hospital, Southern Medical University, Guangdong Provincial Center for Skin Diseases and STD Control, Guangzhou, China

Abstract

Background: Penicillins are the most commonly prescribed antibiotics; however, penicillin allergy (PA) labels are highly prevalent and often inaccurate, leading to suboptimal antibiotic selection use. In Mainland China, PA mislabeling is exacerbated by inappropriate penicillin skin testing (PST) practices. Nurses play a crucial role in assessing and labeling suspected PA, but the lack of systematic, evidence-based training limits their ability to address mislabeling effectively.
Objective: To evaluate the impact of a structured one-day PA training course targeting nurses on their knowledge and self-reported confidence in PA assessment and skin testing practices.
Methods: A quasi-experimental pre- and post-test design was employed with 60 nurses in Mainland China who completed training course. Knowledge and self-reported confidence were assessed using a standardized 0–100 questionnaire (≥ 70 = satisfactory) before training and at 1-month follow-up. Baseline results were also compared with those of nurses in Hong Kong.
Results: At baseline, overall knowledge did not differ significantly between Chinese Mainland and Hong Kong nurses, but Mainland nurses scored lower on PST–related practical knowledge questions (63.5 ± 32.9% vs. 56.6 ± 23.6%; p = 0.031). Following the training, there were significant improvements in both knowledge (64.3 ± 18.8 to 86.9 ± 9.9; p < 0.001) and self-reported confidence (72.0 ± 12.6 to 81.9 ± 8.7; p < 0.001). The proportion achieving a “satisfactory” score increased from 45.0% to 93.3% (p < 0.001).
Conclusion: A structured one-day training program significantly enhanced nurses’ knowledge and confidence in PA assessment and PST. These findings support the integration of standardized, evidence-based PA training into nursing curricula, which may contribute to reducing mislabeling and promoting optimal antibiotic stewardship.
Key words: allergy, education, labelling, nurses, penicillin, practice, skin tests