PharmD & Iowa Methodist Medical Center
When asked, “what is your professional goal?” Dr. Geoff Wall says, “I’m there.” Dr. Wall loves his practice; he says the best seven years of his professional career have been with Iowa Methodist Medical Hospital in Des Moines, Iowa. As a residency program director, faculty at Drake University, and respected clinician Dr. Wall says, “I just want to keep pushing the boundaries.” And so he does.
Dr. Wall started his education at the University of Utah, completing his Bachelor of Science in Pharmacy in 1992. Throughout school he worked in an area hospital and upon graduation took a position as a retail pharmacist. He says that about two months into that position he realized he preferred hospital practice and left to be a staff pharmacist and eventually the director of pharmacy in a small hospital in Utah. By 1998 he had graduated as a Doctor of Pharmacy from Idaho State University and took a Pharmacy Internal Medicine residency at Temple, Texas. In 1999 Dr. Wall joined the faculty at Drake University College of Pharmacy and Health Sciences with a clinical position at Iowa Methodist Medical Center.
Development of a Pharmacy Practice Residency and participation as an instructor in the Medical Residency Program at Iowa Methodist are just a few of his accomplishments. The most recent practice advancement for pharmacists under Dr. Wall’s instruction at Iowa Methodist has been the development of a penicillin allergy skin testing program.
Many hospital pharmacists are involved in the antibiotic decision making process and Dr. Wall believes pharmacists’ have the responsibility of antibiotic stewardship, which is to assure patients receive appropriate antibiotics based on safety an patient specific efficacy factors. Dr. Walls’ penicillin allergy testing program evolved though the common dilemma of patients who declare a penicillin allergy (up to 20%) but are often unable to adequately describe their reaction. This often limits the healthcare teams in the antibiotic selection, which leads to use of broad spectrum antibiotics which subsequently, increases the risk of future antibiotic resistance. Yet a penicillin-class antibiotic is still the drug of choice in many situations.
In what he describes as a fortuitous move, Dr. Wall worked with Dr. Jim Willie in Iowa Methodists’ allergy clinic to learn about penicillin allergy testing. He was convinced that a properly trained pharmacist could read a penicillin skin test and set about the process of training. Dr. Wall and his team of pharmacists underwent didactic and practical training with an allergy specialist. They practiced the skin scratch test and intradermal injection techniques on each other and developed the only penicillin desensitization program in the world. Through the use of Pre-Pen® (benzylpenicilloyl polylysine), penicillin G, histamine and saline they have perfected the technique to identify a patient’s reaction to the metabolite of penicillin that is responsible for most dangerous allergic reactions to penicillin. This testing reopens the arsenal in situations where penicillin or a derivative is the best treatment option.
To learn more about the penicillin desensitization program at Iowa Methodist Medical Center in Des Moines, Iowa review the results published in AJHP or contact the DELTA Rx Institute to schedule a one-day traineeship with Dr. Wall.
How did Dr. Wall identify the opportunity for a penicillin desensitization program?
In this case, the opportunity was the result of necessity. While new antibiotics are being discovered and marketed each year, they are not effective against every bacteria. As a pharmacist consulting on antibiotic selection Dr. Wall saw that in some areas they were out of options, they simply had to use penicillin. Frequently patients report a penicillin allergy because their parents told them they had a bad reaction when they were young. Side effects such as nausea are common with the use of penicillin and do not signify an allergy. Utilizing this knowledge, Dr. Wall decided that if he could cautiously test for true penicillin allergy versus an expected side effect, the knowledge could reopen the door for the use of this essential medication.
How did Dr. Wall acquire the necessary resources? Were there ever challenges?
When Dr. Wall began this project there was only one company in the world making Pre-Pen® (benzylpenicilloyl polylysine), the penicillin metabolite and component most patients are allergic to. During the time of implementation and management of this project that company was forced to close by the FDA. This temporarily cut off the distribution channel. Now, a group of physicians has purchased that company and intends to make the supplies available as soon as they can.