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First lifetime dose policyFirst Lifetime Dose Policy
PURPOSE: To describe the limitations associated with the first dose of an intravenous or injectable medication to be administered in the home. CONSIDERATIONS: 1. The term “first dose” shall refer to a patient’s first known exposure to a medication. All options for having the first dose of a medication administered in a hospital setting, or a physician’s office under the supervision of a physician or the physician’s designee should be considered before administering the medication in the home. Several criteria must be considered in order to make the decision regarding whether the first dose of a medication can be administered in the home. The nurse will consult appropriate drug reference books and/or a pharmacist to become familiar with the medication. a. The patient will be evaluated for any history of an allergy or adverse response to: a medication that has a known cross-allergenicity with any medication in that classification (e.g., penicillin and cephalosporin). b. Medication to which a patient has a known or suspected allergy or sensitivity may not c. A physician must be readily available by telephone during administration of the first d. Emergency transport services and treatment must be available to the patient in the 4. If all above criteria are met, then the medication will be considered appropriate for the first 5. A physician order must be obtained that specifies that the first dose is to be administered in the home. The physician order shall include orders for allergic or anaphylactic reaction, if appropriate. 6. If the criteria are not met for first dose administration in the home the nurse’s supervisor is to PROCEDURE: 1. Adhere to Standard Precautions. 2. Explain procedure to patient. 3. Follow appropriate medication and infusion procedures. 4. Discard soiled supplies in appropriate containers. AFTER CARE: Document in patient’s record: 1. Medication administered, dose, time, rate, route. 2. Patient’s response to procedure, side effects and management. 3. Instructions given to patient/caregiver. 4. Communication with physician. Visiting Nurse Associations of America Nursing Procedure Manual, 1/2002 List for determining "first lifetime doses"
MACROLIDES - An allergy to any of these is considered an allergy to all.
E-mycin, PCE, Ilosone, Eryc, Pediazole yes FLUOROQUINOLONES – An allergy to any of these is considered an allergy to all.
TETRACYCLINE~ An allergy to any of these is considered an allergy to all.
Note: Vancomycin, clindamycin, & lincomycin are not cross allergenistic with the macrolides.
AMINOGLYCOSIDES -An allergy to any of these is considered an allergy to all.
PENICILLINS - An allergy to any of these is considered an allergy to all.
Approximately 10% of Penicillin allergic patients are also allergic to cephalosporins! CEPHALOSPORINS – An allergy to any of these is considered an allergy to all.
SULFONAMIDES - An allergy to any of these is considered an allergy to all
* may be cross allergenistic with penicillins and cephalosporins Management Reviewed: 5/26/99, 04/24/2002, 07/07/2004, 07/07/2004 PAC reviewed/approved: 05/07/97,6/14/99, 05/08/2002, 07/14/2004 Board reviewed/approved: 06/18/97, 6/16/99, 06/19/2002, 10/12/2004 Current Clinical policies/First Lifetime Dose Policy 2004
BOOKS OCTOBER 15, 2007 VOLUME 85, NUMBER 42 PP. 44-45 Weighing Toxic Torts Book outlines the gulf between science and the law Reviewed by Bette Hileman Individuals or groups who claim harm from a pharmaceutical or chemical may sue the manufacturer or other responsible party in court in what is known as a toxic tort—or personal injury—lawsuit. In the popular imagination, often