Penicillin Desensitization of the Pregnant Patient



[pic] DOCTOR’S ORDER SHEET

|DRUG ALLERGIES: |

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PATIENT IDENTIFICATION ROOM NO.

ORDERS FOR PENICILLIN DESENSITIZATION

OF THE PREGNANT PATIENT (06/2014) – Page 1 of 2

|DATE |TIME | ORDERS FOR MEDICATION, DIET AND TREATMENTS |

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| | | 1. Diagnosis: Penicillin allergic – Desensitization indicated for treatment. |

| | | 2. Admit to AICU or Labor & Delivery between 8AM-10AM. |

| | | 3. Notify Maternal Fetal Medicine MD, Anesthesiologist, and AICU/L&D staff of patient’s arrival |

| | | on unit. |

| | | 4. External fetal monitoring with strip if 23 weeks or greater gestation per L&D nurse. |

| | | Continuous cardiac monitoring per AICU staff. |

| | | 5. NPO. Clear liquids may be given one hour after therapeutic dose. Regular diet 2 hours |

| | | after therapeutic dose. |

| | | 6. IV of LR with 18 G cathlon. May use local anesthetic 1% Lidocaine (Xylocaine) at site. |

| | | KO rate unless otherwise specified. |

| | | 7. Notify Maternal Fetal Medicine MD of any medication taken in the last 96 hours. |

| | | 8. Obtain baseline vital signs, EKG strip, peak flow spirometry, and fetal monitor strip for 30 mins. |

| | | 9. Medications readily available : |

| | | a) Epinephrine 1:10,000 injection (If required, initial dose to be 0.1 mg IV over 5 minutes) |

| | | b) Diphenhydramine (Benadryl) 50 mg IV Push |

| | | c) Hydrocortisone 100 mg injection (If required, dose may be administered IV Push over 30 |

| | | seconds) |

| | |10. Obtain Penicillin V Potassium using 250* mg/5 ml as base solution. (*400,000 units = 250 mg) |

| | | Solution 1 – Penicillin V Potassium 1,000 units/ml |

| | | Solution 2 – Penicillin V Potassium 10,000 units/ml |

| | | Solution 3 – Penicillin V Potassium 80,000 units/ml |

| | |11. Begin oral desensitization Steps 1-14 as indicated on Page 2 of 2. Interval between steps |

| | | is 15 minutes. |

| | |12. If allergic reaction observed, stop desensitization immediately and notify Maternal Fetal |

| | | Medicine MD. |

| | |13. Report any abnormal patient/fetal assessments to the physician immediately. |

| | |14. Observe for 30 minutes following completion of oral doses and before beginning intramuscular |

| | | administration of penicillin. |

| | |15. Notify Maternal Fetal Medicine MD/Anesthesiologist of completion of desensitization. |

| | |16. Continue with regular therapeutic doses as ordered per Maternal Fetal Medicine MD. |

| | |17. Observe the patient on continuous cardiac and fetal monitors for 24 hours after therapeutic |

| | | dose. (Continuous fetal monitoring if greater than 23 weeks gestation.) |

| | |18. Following physician order for discharge, review the following with the patient: |

| | | a) Post penicillin desensitization discharge instructions with follow-up appointment. |

| | | b) Give copy of Fetal Movement Counting Instructions if over 28 weeks. |

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06/2014 ORDERS FOR PENICILLIN DESENSITIZATION OF THE PREGNANT PATIENT

Page 1 of 2

PENICILLIN DESENSITIZATION DOSING SCHEDULE

ORAL

| |Step |Penicillin V |Amount (ml) |Dose |Cumulative |Cumulative |

| | |Potassium (Units/ml) | |(Units) |Dosage |Time Course |

| | | | | |(Units) | |

| |1 |1,000 |0.1 |100 |100 | |

| | | | | | | |

| | | | | | | |

|Solution 1 | | | | | | |

| |2 |1,000 |0.2 |200 |300 | |

| |3 |1,000 |0.4 |400 |700 | |

| |4 |1,000 |0.8 |800 | 1,500 | |

| |5 |1,000 |1.6 | 1,600 | 3,100 | |

| |6 |1,000 |3.2 | 3,200 | 6,300 | |

| |7 |1,000 |6.4 | 6,400 | 12,700 | |

| |8 | 10,000 |1.2 | 12,000 | 24,700 | |

|Solution 2 | | | | | | |

| |9 | 10,000 |2.4 | 24,000 | 48,700 | |

| |10 | 10,000 |4.8 | 48,000 | 96,700 | |

| |11 | 80,000 | 1 | 80,000 | 176,700 | |

|Solution 3 | | | | | | |

| |12 | 80,000 | 2 | 160,000 | 336,700 | |

| |13 | 80,000 | 4 | 320,000 | 656,700 | |

| |14 | 80,000 | 8 | 640,000 |1,296,700 |195 min. |

06/2014 ORDERS FOR PENICILLIN DESENSITIZATION OF THE PREGNANT PATIENT

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