Anesthesiologists found underreporting Medication Errors.

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Noyac

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I'm on call tonight so I'm reading some mindless anesthesia magazine. I came across an article I'm sure most of you have seen, see title.
I had a couple questions. First, it states "Anesthesiologists" are to blame. But in the article it's graph shows that the anesthesiologists are responsible for only 4% of the errors while residents and crna's make up 87% of the errors. We all know that is because in academic centers like UM the anesthesiologists don't push the drugs. But still, the title irked me a bit.
However, that's not the what pissed me off the most. They called, giving a cephalosporin to someone with a known PCN allergy, a medication error. Since when? I do this all the time. It is well documented that this is a perfectly acceptable practice. So this entire study is crap.

It's stupid studies Like these that the sensationistic media gets a hold of and runs with to incite fear in the general public. And it's put out by our own peers.

I support the study idea but get it right and do your research. Don't publish just to get your name out there.

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They called, giving a cephalosporin to someone with a known PCN allergy, a medication error. Since when? I do this all the time. It is well documented that this is a perfectly acceptable practice. So this entire study is crap.
Not only is it acceptable practice, it's best practice. It kills me that I can't get people to understand this.

Your larger point is well taken. So much absolute BS being put out there these days.
 
Not only is it acceptable practice, it's best practice. It kills me that I can't get people to understand this.

Your larger point is well taken. So much absolute BS being put out there these days.

It depends on the allergy though, doesn't it? If someone has a PCN allergy with anaphylaxis as the reported reaction, I wouldn't take the 10% cross-reactivity risk. If it's just rash, itchiness, or whatever. Yeah sure no problem.
 
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It depends on the allergy though, doesn't it? If someone has a PCN allergy with anaphylaxis as the reported reaction, I wouldn't take the 10% cross-reactivity risk. If it's just rash, itchiness, or whatever. Yeah sure no problem.
You should be informed if you are the one giving the drug.
10% report a PCN allergy but only 1% have a true Ig-E mediated one. And 80% of this 1% will lose their allergy to PCN in 10yrs.

https://www.cdc.gov/getsmart/week/downloads/getsmart-penicillin-factsheet.pdf
 
It depends on the allergy though, doesn't it? If someone has a PCN allergy with anaphylaxis as the reported reaction, I wouldn't take the 10% cross-reactivity risk. If it's just rash, itchiness, or whatever. Yeah sure no problem.

It's not 10% cross reactivity, thats outdated. it's more like 1% or around that ballpark. with that said, i would give something else if its anaphylaxis, simply not worth the risk
 
It's not 10% cross reactivity, thats outdated. it's more like 1% or around that ballpark. with that said, i would give something else if its anaphylaxis, simply not worth the risk

Seems like the % varies depending on whether it's a confirmed allergy (2.5%) vs reported allergy (1%). Either way, the point is, it will almost always be fine to use Cephalosporins, but use common sense and exercise caution if the reported PCN allergy is life-threatening.
 
You can't win with this kind of nonsense. Giving a cephalosporin in a patient with a vague or fake PCN allergy is not a medication error and probably the best thing to do in the name of antibiotic stewardship. We should be using more penicillin and narrower spectrum antibiotics whenever possible. However, let's imagine a scenario where we were giving all these fake PCN-allergic patients broad spectrum alternatives. Now you have an article where they point the finger at us saying we're responsible for antibiotic resistance. You can't win. You can find a statistic to fit any argument you want. Many of the articles written in those throwaway journals are simply written to pad CVs.
 
I'm not sure if it's from the same article or not, I don't feel like looking for it, but there was a medication error "study" put out sometime in the last year that looked at post-induction BPs and if any hypotension was seen beyond a given threshold they called it a propofol medication error due to too large a dose.

Edit: You know, because there are expert witness types that will argue propofol should only be given in carefully titrated 20mg boluses....
 
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It depends on the allergy though, doesn't it? If someone has a PCN allergy with anaphylaxis as the reported reaction, I wouldn't take the 10% cross-reactivity risk. If it's just rash, itchiness, or whatever. Yeah sure no problem.

It was reported as 10% in the days where the drugs were not as well made as they are now and there was some cross contamination. In true penicillin allergy, <1% have an allergy to cephalosporin
 
No crossreactivity with second or higher generation cephalosporins. Only crossreactivity with 1st Gen and then only low %. Nejm 2011 paper iirc

The reaction is not to beta lactam ring but the 2nd side chain

Some micro idiot in our hospital wants us to give vanc to everyone with pen allergy 30min preop...
 
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It was reported as 10% in the days where the drugs were not as well made as they are now and there was some cross contamination. In true penicillin allergy, <1% have an allergy to cephalosporin


Agree with Gravelrider that this is nonsense.

Doubt it was ever 10%. Probably far less than 1%. I've personally given cefazolin to "pcn allergic" patients at least a thousand times and never seen a reaction. In fact I've never ever seen an allergic reaction that I could definitively attribute to cefazolin, cefoxitin, or cefotetan. And I've probably given around 20,000 doses.
 
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