Why does the cefolosporin test continue to be banned?

Source: Figureworm

Case source 1

Chatting with classmates, I learned that some time ago, the director of the nursing department of their hospital directly forwarded the "Guidelines for skin testing of β lactam antibacterial drugs" issued by the National Health Commission to the head nurse group, so that the head nurse organized the study, and did not explain how to implement it. And their doctors are still under the order of the cephalosporin skin test, implement it, contrary to the national guidelines, do not implement it, and violate the principle of medical order implementation. But the classmates were embarrassed, so the phone called the nursing department, and the director of the nursing department said that the nursing department could not manage the doctor.

Case source two

Nurse F was assigned to neurosurgery support, and on the first day of the work, he was told by the head nurse when he was assigning a penicillin skin test for the patient. The reason is that the configuration method of Nurse Little F is configured according to the textbook of "Basic Nursing", and the concentration of the skin test is 400 units /ml, while the concentration of neurosurgery is 500 units/ml according to the "Guidelines for Skin Testing of β Lactam Antibacterial Drugs". Nurse Xiao F said aggrievedly: "Our department has always been configured according to the old standard and observed the results. It can be seen that the root cause of this different operation method of the same hospital is still the responsibility of the management department.

Case studies

"Guidelines for skin testing of β lactam antibacterial drugs" was issued by the National Health Commission on April 16, 2021, but the use of antibiotics in medical institutions was jointly completed by doctors, medicines and nursing, which is also the main reason for the embarrassment of the students in case one, the nursing department did not organize relevant learning, only forwarded to the head nurse group, nor did it jointly organize learning with the medical department and issued relevant notices; the doctor in charge did not receive the notice from the medical department, and naturally wanted to make a doctor's order; the pharmacy department has always been a good old man. People don't look for me, I don't look for people, love to do not do, and I have nothing to do with it. Therefore, the nursing staff as the work terminal in the above case can only perform the skin test according to the doctor's instructions.

As far as the author knows, even though some units have issued the guidelines, clinicians and nurses are more willing to implement the original principle of "antibiotics that is, skin tests". The reason is nothing more than the so-called "security". Afraid of unreasonable patients questioning, so even if the people are hurting money, they must follow the rules.

This also sounded the alarm bell for the hospital management department, the hospital is a whole, each department is for clinical services, the various management departments should be interconnected, and the problems are piled up to the clinic is the dereliction of duty of the management department, and it is a manifestation of inaction.

Skin testing is not a means of exemption, and failure to actively treat it is a dereliction of duty

The author co-organized the study of the guiding principles in the province, and the medical department, pharmacy department and nursing department of the unit coordinated to organize and issue relevant regulations. As of last week, the clinical department still conducted skin tests on cephalosporin antibiotics. Respiratory nurses and doctors said in unison that no skin test was done, and no one was responsible for allergic reactions or anaphylactic shock, and that patients did not disagree with the skin test for their own safety. It can be seen that the skin test has become a means of exemption from responsibility for medical staff, and it has become psychological comfort for patients.

Before using cephalosporin antibacterial drugs, the patient must be carefully asked about the history of drug allergies, and should be closely observed within half an hour to 1 hour after the first use, and once there are signs of allergic reactions, they should be treated quickly. The occurrence of allergic reactions is not the responsibility of medical staff, but if they are not handled properly or there are no corresponding treatment measures, medical staff will face certain legal risks.

Here to warn the majority of medical personnel, the state has issued the "guidelines for skin testing of β lactam antibacterial drugs", with the backing of the state, are you still afraid of taking responsibility?

Warn the majority of patient friends, the sensitivity of the cephalosporin drug skin test is not high, and the positive predictive value is 0%, are you still enduring pain for peace of mind?

bibliography

1. Expert Consensus on Skin Allergy Test of Cephalosporin Antibacterial Drugs, China Journal of Practical Rural Doctors, Vol. 16, No. 12, 2009, pp. 54-54.

2. Guidelines for skin testing of β lactam antibacterial drugs.