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SPECIAL FEATURE— CLINICAL EXCELLENCE
Managing Patient Allergies Tips on how to protect patients from adverse reactions to drugs, latex and more. BY ROBERT KURTZ
A
n allergic reaction can cause a pa- tient to develop a minor rash, go
into anaphylactic shock or something in between, says Stacy Zemencik, RN, di- rector of nursing at Summit Ambulato- ry Surgical Centers, which operates 15 ASCs across Maryland. “With a com- mitment to providing the best possible patient experience, ASCs must ensure that allergies are a part of the discussion of care throughout a patient’s time at the ASC,” she says.
That discussion, adds Zemencik,
should begin before the patient even sets foot in the ASC. “When our preop nurse calls the patient and reviews his or her history and medication list, an important part of that discussion is also allergies.” The conversation needs to continue
when patients arrive, before they go under anesthesia and even during recov- ery, when possible, says Betty Mercer, post-anesthesia care unit charge nurse at City Place Surgery Center in Creve Coeur, Missouri. If a patient’s allergy history is con-
cerning, Zemencik recommends that the case be discussed with the ASC’s anesthesia provider and, if necessary, the physician scheduled to perform the pro- cedure. In Summit Ambulatory Surgical Center’s ASCs, those two physicians then make the decision about whether the pa- tient can be cared for safely in the ASC. Other steps ASCs can take to protect patients with allergies include: Draw attention to allergies. “We put a red bracelet on everybody that ei- ther indicates a patient has no allergies or identifies the allergies with small nota- tions of severity,” says Louise DeChess- er, administrator of Middlesex Center for Advanced Orthopedic Surgery in Middletown, Connecticut, and director of clinical services for ASC manage-
With a commitment to providing the best possible patient experience, ASCs must ensure that allergies are a part of
the discussion of care throughout a patient’s time at the ASC.” —Stacy Zemencik, RN, Summit Ambulatory Surgical Centers
ment company Healthcare Venture Pro- fessionals in Brentwood, Tennessee. When a patient has a history of ana-
phylactic-type reactions, Mercer says she makes sure this information is circled in red in the patient’s chart. If a patient develops a new allergy
in your facility, instruct that patient to communicate this information to their primary care provider and any caregiver in the future, DeChesser advises. “We provide a letter to patients who have ex- perienced this in our center that denotes the allergy, type of reaction (mild–se- vere), how it presents (rash–shock) and how we treated the episode. This will be a permanent document that the patient can keep for their records in the future.” Take special precautions. Patients
who present with latex allergies in the ASCs she works with, says Zemencik, undergo their procedures as the first cases of the day. “This is a special policy specific to latex,” she says. “We follow a checks system to make sure that all sup-
34 ASC FOCUS NOVEMBER/DECEMBER 2013
plies we pull are latex free. By making these the first cases, there is no latex in the air from a patient who was in the operat- ing room before them that day.” Mercer says her ASC ties a large,
green, non-latex rubber glove on the end of the beds of its patients with latex allergies. Test medications. If a patient has
never received Ancef, the prophylactic City Place Surgery Center commonly administers to its orthopedic surgery pa- tients, the ASC will often provide a test dose of the drug to the patient. “If they have no reaction, we will give the full dose,” says Mercer. “If they have a reac- tion, we will administer an alternative.” Train for allergic reactions. “We do a mock code every year, and as part of it, we discuss what to do if a patient has an allergic reaction,” Zemencik says. “ASCs need to always be ready to re- spond to any type of patient issue that may arise during a stay.”
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