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@lnln
We are an outpatient and emergency department here, and a patient said he was allergic to cephalosporins, and the doctor on duty is available What should the nurse do if the nurse has to do a cephalosporin test?
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Discussion
Let’s first look at the hot discussions of netizens:
A: In the case of the patient’s self-reported “allergy”, the doctor has reason to prescribe a skin test , even if the skin test is positive, it may not necessarily be the cause of cephalosporin allergy. Nurses need to carry out doctor’s orders. There’s no reason to say that as this is a requirement of the Code of Practice.
B: Before the injection, the medical staff routinely asked about the drug allergy history. It is necessary to communicate with the doctor. I think in this case, this drug can no longer be used, and even a skin test cannot be done. Patient safety is the first.
C: I feel that I can basically conclude that I am allergic to cephalosporins, and I dare not take medicines.
Cases
Before answering this topic, let’s take a look at the personal experience of a nursing colleague:
I had a similar thing happen to me some time ago. One night, after a trauma patient came to my emergency department for debridement and suture, the doctor routinely prescribed tetanus antitoxin. After I got the medicine, I would do a skin test on the patient. During the previous inquiry, the patient complained that he was allergic to the medicine. The doctor on duty explained the situation and suggested direct immunoglobulin (medical compatriots who questioned why they did not go to Baidu for the latest national regulations).
As a result, the doctor on duty was unwilling, but insisted on asking me to do it for the sake of the patient’s economical consideration (200+ one immunoglobulin). Skin test, I once again stated that the risk of redoing the skin test for patients with known allergies is still ignored by the doctor, and I emphasize that I don’t care about your nursing care. I will prescribe a medicine. look. I communicated with another doctor on duty, and the doctor readily prescribed immune globulin to the patient.
Then after the incident passed, I explained the situation to the head nurse, and the head nurse said that what I did was right. If it is known that the patient has a history of allergies (whether it is a positive skin test or a true allergy) and continues to use the drug, then our nursing operation examination does not always need to emphasize the allergy history, and the doctor will use it directly.
Finally, clinical medical treatment and nursing are two systems that need to cooperate and understand each other. Medical treatment cannot replace nursing, and nursing cannot replace medical treatment. Otherwise, it is either the patient or our medical staff who will suffer.
Why is this happening? For various reasons, due to the different positions of medical care, the angle of consideration of the problem is also different.
When encountering such a situation, the first impression given to people is the patient’s self-reported cephalosporin allergy. Basically, it can be concluded that cephalosporin Allergies, and dare not take medicine. There are so many types of drugs available in clinical practice, why hang on cephalosporins?
In today’s world, patient safety has been mentioned as never before. This is what everyone expects, and it is also the responsibility of medical care. However, in the first-line clinical practice, there is no lack of such situations: the allergy mentioned by the patient may be a positive skin test, or it may be an allergy to cephalosporins.
In this case, medical staff should ask carefully to understand two concepts:< /p>
1. Is it a positive skin test or a real allergy?
Whether it is a positive skin test or a real allergy to cephalosporins, medical staff need to ask carefully, confirm the situation, and then make a targeted decision .
Cef allergy and positive skin test are two concepts.
If you are allergic to cephalosporins, then you must consider that this allergy drug can no longer be used. As for the positive skin test, it may be misunderstood by the patient and their family members as “drug allergy”. If the skin test is positive, it may be a false positive. Doctors do not give up, just thinking about whether the drug allergy said by the patient is false or not. positive? I want to try again, try it out, there are some risks, but because some drugs are the first choice drugs, doctors still want to give it a go.
2. What kind of cephalosporin allergy is it?
If you are allergic to cephalosporins, you should also ask clearly, which cephalosporin allergy is it? Because it is the fourth generation of cephalosporins, there are many kinds of them, and there are several commonly used clinically in each department of each hospital.
Clinically chased after: the patient said that he was allergic to cephalosporin, but he was not sure which cephalosporin it was, so the doctor According to the patient’s condition, one of them was preferred, such as cefminox, and the skin test result was negative.
So the general clinical practice is that if the patient is allergic to one of them, they will try the other, and if they are allergic to both, they will be decisive. All cephalosporins were given up.
Countermeasures
1. Double signature of doctor Nurse Ask the patient’s allergy history, and the doctor insists on taking medication. The nurse can ask the doctor to double sign the prescription and leave written evidence after informing the doctor to show caution.
2. Be fully prepared The doctor ordered a skin test. The operation in this case, It is a high-risk operation with certain medical care risks. Nurses should prepare mentally and routinely prepare the rescue box for the skin test. During the skin test, the patient should closely observe the changes in the patient’s condition. Once the patient is in a situation, make timely emergency response at any time to ensure the safety of the patient.
Perception
Some time ago, there was a lesson from the past, I wonder if you still remember it?
The case of “a nurse who followed the doctor’s advice to inject propofol to cause the death of an abortion patient” was sentenced to ten years. Punishment, but the lessons it brings, clinical nurses must learn from them.
Do not execute the doctor’s orders mechanically, and have your own clinical judgmental thinking, otherwise, if something happens to the patient, as the direct operator , the nurse is to blame.
Therefore, it is still necessary to act cautiously to ensure patient safety and nursing safety.
Source: China Medical Network
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