Clinical Implications of Delayed Allergen Testing - Essay Example

? CHANGES NEEDED FOR ALLERGEN TESTING AMONG SURGERY CANDI S Perioperative procedures are routinely done to prepare surgical patients physically and psychologically, as well as to assure their chances of survival during the postoperative phase. While the established procedures in the whole perioperative phase are already accepted to be efficient in keeping the patients safe and comfortable prior to and after the surgery, some changes such as allergen testing may be adjusted to be done at the earliest stages of the perioperative phase. This is important to rule out unscreened potential allergens that could affect the patient during the recovery stage, and might cause problems such as asphyxiation or affecting multiple organs in the process. The implications for stakeholders in adjusting the procedure are that it increases the survival rates of patients, which in turn decreases maintenance costs for the facility. Facilities become much more reliable when the survival rates of surgical patients are high, thus there is a potential increase in patients in the future. Changes Needed for Allergen Testing among Surgery Candidates Clinical Implications of Delayed Allergen Testing Perioperative procedures for patients are normally done in phases prior to and after surgery in order to ensure the safety and comfort of the patient both physically and psychologically (O'Connell-Smeltzer, Bare, Hinkle, & Cheever, 2010). While most procedures such as initial health assessments, family interviews, and teaching about the surgery and its effects to the patient are done routinely and may not directly affect a patient during the intra-operative and post-operative phase, other procedures such as allergen testing which are done less than 72 hours before or after the operation could cause problems for patients, especially among those patients which were not aware of some potential allergens like anesthetic, antibiotics, or latex. Not properly screening for potential allergens could become potentially lethal, particularly during the post-operative phase of pediatric patients, the immune-compromised, pregnant women, the elderly, among others (Chong, Caballero, Lukawska, & Dugue, 2008; Atanaskovic-Markovic, Gavrovic-Jankulovic, Velickovic, et al., 2008; Khan, Holding, Dore, & Sewell, 2010). Since patients are much more vulnerable to possible health complications after the surgery, allergic reactions to items used in the surgery could cause additional problems such as preventing rapid healing of incisions, or multiple organs becoming affected negatively (O'Connell-Smeltzer, et al., 2010). Thus, it is much more efficient to rule out potential allergens in the earliest stages of the perioperative phase of care as compared to doing the procedure after the operation since adjustments to procedures, drugs, equipment, and other necessary items for the surgery can be planned in advance, according to what the patient might need, and possible complications that may arise from unforeseen allergens can be avoided (Khan, et al., 2010). Changes Proposed for Allergen Testing Normally, medical assessment such as identification of potential allergens are done upon admission to the surgical center, and patient records are collected and kept for referencing during the whole surgical procedure (Hepner, 2009). However, allergens are usually tested after the preadmission phase, which decrease the time that possible causes for anaphylaxis can be screened before the operation (O'Connell-Smeltzer, et al., 2010). It is proposed that allergy tests such as skin patch tests and intradermal skin tests be done during the preadmission stage, so as for medical personnel to gauge necessary alterations in the procedures should the patient present some allergies to drugs or some disposable equipment. In order to keep the test as cost-effectively as possible, patients that may be much susceptible to allergens should get the early allergen testing prior to being admitted to the surgical center, such as pediatric patients, patients without any complete records or known history of potential allergens, pregnant women, and geriatric patients. Screening for elevated IgE levels among patients that do not have prior records of potential allergens can also help in identifying whether the said patient may have susceptibility to routinely-used medical equipment such as anesthetic masks, latex gloves, or drugs such as painkillers (Kahn, et al., 2010). Because the tests are done early, results would also be generated early, thus plans for the operation may be either adjusted or cancelled, depending on the results of their allergen tests. This saves time and money for patients, especially those which may have to undergo additional tests to make the body optimally-fit for surgery (Hepner, 2009). Patients that have partial or extensive records and history of known allergens may omit this procedure and proceed to be admitted in the surgical center as normal. Involving Stakeholders in the Proposed Changes Stakeholders such as patients, members of the health care facility, and other people that would be directly or indirectly affected by changes in the procedures would benefit from performing the allergen testing early in the perioperative phase from being immediately prior to and after the intraoperative phase. While this may initially seem costly for the patients, as well as increases the length of the preadmission stage, it is much more cost-efficient than having to treat possible organ complications which could have resulted from unscreened allergens (Atanaskovic-Markovic, et al., 2008). Also, because potential allergens can be identified, these can also be added to the patient’s records for future referencing (Kahn, et al., 2010). As for the medical personnel, the adjustments that can be made to the procedures that will be done during the course of the intraoperative phase could help increase the chances for survival by the patient, since all possible threats to patient safety were already identified. This is essential especially when the patient has to be given numerous drugs in rapid succession, and if allergens were not screened out from the very beginning, it would be harder to trace which drug might have caused adverse reactions (Chong, et al., 2008). For other stakeholders such as the government or companies that sponsor foundations in medical facilities, the implications of improving allergen screening among incoming patients not only conveys the increase in the quality of the standard operating procedures of the hospital, but also assures the increased safety and survival rates of surgical patients in said hospital, which in turn shows the reliability and capabilities of its medical personnel. By adjusting the procedures to increase survivability among surgical patients, hospitals can become much more competent and reliable in comparison with the competition, and mentioning these proposed changes to all stakeholders could help them in deciding whether or not to include such changes in the original perioperative protocols in the medial facility. Essay There were difficulties in translating the researches into practice, since the conclusions of the studies used for this paper as well as the full account of the methods of each research were shortened to decrease the length of the report. The reports were also specific only to certain allergens, such as latex, certain polypropylene medical equipment, drugs such as painkillers and antibiotics, and even anesthetic agents. Also, there were much more focus on much more susceptible patients such as children, pregnant women and the elderly, but data were limited to patients without any pre-existing conditions. Lastly, the numerous methods that had to be collated due to various allergen tests that were used in each study had to be synthesized, and because some were expected to generate much rapid results compared to others, data generated for each report would have various implications and effects depending on the patient, thus a need to fully synthesize all studies and find common denominators to explain the results fully. Based on the evidences in the studies, it is possible to implement allergen testing earlier in the perioperative processes. However, it would be a challenge to implement such changes within a medical organization, especially when the methods that are to be subjected to changes have already been well-established in the medical community. Also, possible barriers to implementation of such methods might be dependent on the consent or the initiation of patients, and that some may be reluctant to undergo such changes if the need to undergo such tests were not properly explained to them prior to the tests or the surgery. Other possible hindrances to the implementation of early allergen testing would be the facility itself, or the lack of personnel that could handle such tests or are knowledgeable with most of the pertinent procedures that can be done. However, explaining fully the implications of implementing such tests within the medical facility’s members could help in its inclusion and acceptance among the changes in perioperative procedures within the hospital. The findings that were used in this study can be used in the implementation of early allergen testing among surgical candidates, especially amongst those which have no knowledge of what possible antigens that could easily affect them. One strategy to help assist in the effective implementation of the early administration of allergen tests is by explaining to surgical candidates the possible consequences of being unaware of what allergens that they might be susceptible to, as well as identifying these at an earlier stage. This knowledge could help medical personnel decide which procedure would be most suitable for the patients, since it could help rule out possible allergies that could affect them after the operation, ensuring the increased chances of safety and survival. Another strategy would be to initially test the changes and check if any evidences can be gathered in assessing the effectiveness of having patients get tests for allergic reactions early in the perioperative stages, as well as seeing if there would be significant changes among patients before and after the implementation of these changes. Possible ways that could guide in changes of preadmission tests such as in the administration of allergen tests among surgical patients may be to initially implement them among certain age groups and patient classifications first, and then assessing as to whether enough data were generated to deem the practice reliable based on the evidences that were gathered during a certain period of implementation. Previous data on the survival rate and the number of complications that were recorded among patients before the implementation of changes can be used to check whether there was significant improvement of survivability and decrease in complications among patients that underwent early allergen screening or not, and can be the gauge on whether to continue with the implementation or not. References Atanaskovic-Markovic, M., Gavrovic-Jankulovic, M., Velickovic, T., Vuckovic, O., Ivanovski, P., Nestorivic, B., Cuturilo, G, & Simic, D. (2008). Intraoperative anaphylactic shock in a child with no history of type I hypersensitivity. Iranian Journal of Allergy, Asthma, and Immunology, 97-99. Chong, Y. Y., Caballero, M. R., Lukawska, J., & Dugue, P. (2008). Anaphylaxis during general anaesthesia: one-year survey from a British allergy clinic. Singapore Medical Journal, 49(6): 483-487. Hepner, D. (2009). The role of testing in the preoperative evaluation. Cleveland Clinic Journal of Medicine, 76(4):22-27. Khan, S., Holding, S., Dore, P., & Sewell, C. (2010). Pitfalls in the diagnosis of latex allergy. Allergology International, 59(3): 305-308. O'Connell-Smeltzer, S., Bare, B., Hinkle, J., & Cheever, J. (2010). Brunner and Suddarth's Textbook of Medical Surgical Nursing. Philadelphia, PA: Lippincott Williams & Wilkins. Read More