Importance of nurse involvement
The person who patients believe to be the most trustworthy in the hospital is the nurse.  The nurse is the person who spends the most time at bedside, and will be entrusted with detailed personal information. It is the nurse’s duty to be aware of the potential sub optimal care a patient could receive by being mislabeled with a penicillin allergy. This can be done by getting a thorough drug reaction history to identify true penicillin allergy. Although nurses may not be able to always resolve the issue on their own, they can advocate for patients who would be good candidates and ultimately benefit from penicillin allergy testing. 

Why is participation limited
The first method of challenging a penicillin allergy once a patient has been labeled with the allergy is a skin test. This is a simple procedure that a nurse can be taught and shown how to interpret, but finding time for training can be difficult. The PRE-PEN company has three components to teaching, first online lessons, followed by a 90-minute in-service while practicing on others in the class, followed by testing on three patients within eight weeks of the training (PRE-PEN, 2017). However, in order for nurses to be trained to do skin testing, administration and physicians needs to be aware of the importance of the training and financial implications of not having patients tested. 

It is important to educate nurses what side effects can happen when a person takes penicillin. It is also important to teach the nurse what a true allergic reaction to penicillin looks like. Once the nurse is aware of the different signs and symptoms, they can then educate the patient. The nurse can also educate the patient on the importance of skin testing to either confirm or rule out true penicillin allergy. A patient may not be able to have testing while in the hospital but can ask for a referral to see an allergy specialist after discharge. The skin test is usually covered by insurance. Once a patient has a negative skin test, the allergy can safely be removed from their medical and pharmacy records. 

 

A hard stop questionnaire would force the nurse to ask a series of questions regarding any reported penicillin allergy. The questions would be yes or no answered with responses scored. A higher score would indicate a likely allergy and the label could be added to the chart. Moderate would need interventions before labeling such as a skin test. A low score would not allow the allergy to be added to the chart. This could be because the patient did not have a severe allergic reaction, only generalized side effects, or have had a penicillin or beta-lactam before without a reaction. Although this may take more time during the nurse's admission assessment, creating a hard stop questionnaire before adding a penicillin allergy to a patient’s chart will provide thorough documentation and also prevent mislabeling. 

 

The company who makes the penicillin allergy skin test has an education plan set up for any healthcare member who has the qualifications and skills to perform the procedure. Nurses have learned critical thinking and psychomotor skills to administer medications and asses for adverse reactions. Teaching nurses to perform a skin test should be a task within their scope of practice to accomplish and interpret. 

A focused assessment is “performed to obtain data about an actual, potential, or possible problem that has been identified or is suspected” (Treas & Wilkinson, 2014, p. 42). This information is gathered and added to a comprehensive assessment. When a patient has a reported penicillin allergy, it is important for the nurse to complete a focused assessment and add it to the patient’s chart noting the signs and symptoms they experienced. Completion of this assessment puts the nurse into a leadership role by advocating for the patient for further testing to rule out a possible mislabeled penicillin allergy. The leadership the nurse takes will improve patient outcomes, lower costs, and prevent longer hospital stays if alternative antibiotics need to be used. 

 

2) Ethics in Nursing 

Ethics of care “directs attention to the specific situations of individual patients, viewed within their own life narrative” (Treas & Wilkinson, 2014, p. 1533). Ethics guide the care nurses provide to their patients. One of the moral concepts that nurses follow when making ethical decisions is nonmaleficence, which means to do not harm and prevent harm. Risk of harm is not always clear, so the nurse must use critical thinking and leadership to make sure that the treatment plan does not cause more harm than good. If the nurse recognizes the patient would benefit from a beta-lactam antibiotic and they have a documented allergy due to a side effect, the nurse should advocate for the patient, encouraging the provider to order allergy testing before immediately going to a broad-spectrum antibiotic. 

 
If you have any questions please reach out to me and I will get back to you promptly. Thank you for taking the time to view my padlet presentation about the dangers of mislabeling a patient with a penicillin allergy and the important role the nurse has in improving patient outcomes. I hope this has transformed the way you view penicillin allergies and taught you some ways to help patients, family members, or friends from being mislabeled. Thank you.