Penicillin allergy de-labelling by non-allergy specialists in the elective surgical setting: A mixed-methods systematic review protocol.

Penicillin allergy labels are common in elective surgical patients, although most are incorrect. These labels often prevent the use of first-line surgical prophylaxis, and alternative antibiotic choices are associated with patient harm and antimicrobial resistance. There is a need for effective pre-operative penicillin allergy de-labelling services, but demand cannot be matched by allergists alone, making non-allergist-led approaches particularly important. Such services have been implemented in a range of health care settings, although their design, level of allergist supervision, implementation and clinical effectiveness vary. The elective surgical population is a promising cohort for these interventions, but has been studied less than inpatient groups. We aim to synthesise quantitative and qualitative evidence on non-allergist-led penicillin allergy de-labelling interventions in elective surgical populations. Studies involving penicillin allergy de-labelling by non-allergist healthcare professionals in the elective surgical setting will be eligible, including quantitative studies of clinical effectiveness and economic evaluations, and qualitative studies exploring experiences, perceptions or implementation factors. A mixed-methods systematic review will be conducted using a convergent segregated approach in line with Joanna Briggs Institute methodology. Systematic searches will be performed across MEDLINE, Embase, CINAHL, Web of Science, Scopus and ClinicalTrials.gov. Studies will be screened and data extracted independently by two reviewers. Quantitative and qualitative findings will be synthesised separately and then integrated to identify convergence, divergence and complementarity.