Nursing Lessons:  Medication related Coroners Case

Nursing Lessons: Medication related Coroners Case

‘In this edition, we look once again at medications, this time with a focus on medication allergies. Anaphylaxis is the most severe form of allergic reaction requiring urgent medical treatment, and multiple definitions for it exist. According to the Institute of Allergy and Infectious Disease and Food Allergy and Anaphylaxis Network, anaphylaxis is highly likely when any one of the following three criteria are fulfilled:
1. Acute onset of an illness (minutes to several hours) with the involvement of the skin, mucosal tissue, or both (e.g. generalized hives, pruritus or flushing, swollen lips-tongue-uvula) and at least one of the following:

a. Respiratory compromise (e.g. dyspnoea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxaemia)
b. Reduced BP or associated symptoms of end-organ dysfunction (e.g. hypotonia [collapse], syncope, incontinence)

2.Two or more of the following that occur rapidly after exposure to a likely allergen for that patient (minutes to several hours):

a. Involvement of the skin-mucosal tissue (e.g. generalized hives, itch-flush, swollen lips-tongue-uvula)
b. Respiratory compromise (e.g. dyspnoea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxaemia)
c. Reduced BP or associated symptoms (e.g. hypotonia [collapse], syncope, incontinence)
d. Persistent gastrointestinal symptoms (e.g. crampy abdominal pain, vomiting)

3.Reduced BP after exposure to known allergen for that patient (minutes to several hours):

a. Infants and children: low systolic BP (age specific) or greater than 30% decrease in systolic BP
b. Adults: systolic BP of less than 90 mm Hg or greater than 30% decrease from that person’s baseline.

Hospital admissions for anaphylaxis are rising, and antibiotics make up a large proportion of the medications implicated in anaphylaxis. In many countries, medications are the most common cause of fatal anaphylaxis – not every case is an unforeseeable event. So why are patients being given medications that they are allergic to? Why are the systems failing in what would appear to be a simple and preventable cause-and-effect scenario?

Anaphylaxis to a known medication allergy should not occur. Effective alert systems must be implemented that ensure universal recognition of a medication allergy every time and in every circumstance.

 

Authored by: The Communiques

Leave a Reply

Your email address will not be published. Required fields are marked *