The Allergy Conundrum

To administer, or not to administer? That is the question...

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We recently responded to a client’s question about an eye drop allergy. An ophthalmologist ordered ofloxacin for a patient who had reported an anaphylactic reaction to Levaquin. A nurse caught the order and held the drug. The case went to peer review, and the reviewer concluded that ofloxacin was an inappropriate choice of eye drop for this patient. After the review process was completed, the ophthalmologist’s final comment on the case was that their initial order of ofloxacin for the patient with a Levaquin allergy was ok because, “no chance of reaction with eye drop”.

We know that in this case, administering the ofloxacin to that patient would likely have resulted in an anaphylactic reaction. We even know what eye drops would be safe or unsafe to use in that instance. The question then becomes, how do we prevent this error from happening, even when the ordering physician doesn’t agree with the suggested practice?

This case study presents itself as an excellent learning opportunity. Consider these questions:

· What processes could be put into place to prevent a nurse from administering a drug contraindicated for allergic reaction?

· Does your facility have a process in place for bringing “good catches” or “near misses” to peer review?

· Does your facility have a non-punitive culture that empowers staff to hold an order for a potentially contraindicated drug?

· How would your facility approach the situation if after review, the ordering physician disagreed with the peer review outcome?

For Ofloxacin allergy, avoid other fluoroquinolones

Ofloxacin (Ocuflox) and Levaquin (levofloxacin) are both fluoroquinolones. Allergies to fluoroquinolones are usually reported within hours of administration and are commonly reported as anaphylaxis (either anaphylaxis or nonimmunologic anaphylaxis, formerly known as an anaphylactoid reaction). Symptoms include erythema, pruritus, angioedema, and urticaria. In some cases, bronchospasm, hypotension, and/or shock can occur.

Consult an eye drop allergy reference chart, (contact us for a copy!), to determine if it’s safe to administer an eye drop to patient with a known allergy.

For more information on fluoroquinolone allergies, read the related article.

Preventing Medication Errors due to Known Allergies

If a patient reports a drug allergy upon admission, ensure that it’s labeled clearly on the front of the chart, or that it’s prominently noted in any electronic record. Counsel staff to check for cross sensitivities before administering drugs to patients with known drug allergies. A great

place to start is JDJ Consulting’s Penicillin Allergy Chart, (Contact us for a copy!). If you or your staff are unsure whether a drug is safe to administer, call us! We’ll verify the safety of the drug you’d like to administer and if there is a contraindication due to allergic reaction, we’ll offer an alternative drug to administer.