Food allergy history and reaction to propofol administration in a large pediatric population.

BACKGROUND: Anaphylaxis to propofol is rare; however, providers face a clinical quandary as medication warnings still exist regarding propofol administration to egg-, soy-, and peanut-allergic patients. AIMS: The primary aim evaluated the rate of allergic reactions during propofol-containing anesthesia in patients listed allergic to egg, soy, or peanut compared with nonallergic patients who received propofol. The secondary aim evaluated the relationship between food allergy history and allergy testing data. METHODS: A retrospective chart review conducted between May 2012 and October 2018 identified pediatric patients listed allergic to egg, soy, and/or peanut, who received propofol. Allergy testing and results are presented. Evidence of allergic reaction to propofol during anesthesia was evaluated, and compared with a large nonallergic cohort who received propofol. RESULTS: Of the 232 392 anesthetics administered, 177 360 (76%) included propofol and 11308 (6%) involved a patient listed allergic to at least 1 index food. A large number of patients had no food allergy testing (n = 6153) or negative testing (n = 2198). Of the 3435 patients listed egg-allergic, 976 tested positive; 750 tested negative; and 1709 had no testing. Of the 2011 patients listed soy-allergic, 322 tested positive; 585 tested negative; and 1104 had no testing. Additionally, 5862 patients were listed peanut-allergic; 1659 tested positive; 863 tested negative and 3340 had no testing. One record of proven propofol anaphylaxis occurred; it was in a patient without a history of food allergies. There were 6 other cases of suspected allergy to propofol. One had a peanut and tree nut allergy and was lost to follow-up; one had no testing available, while 4 patients had positive propofol allergy testing and positive allergy tests to other medications. The rate of proven propofol anaphylaxis during anesthesia in the nonallergic cohort was 0.06/10 000, and the rate in egg- and soy-allergic patients was 0/5446. One patient with a listed peanut allergy had a possible reaction to propofol. CONCLUSIONS: In the listed food-allergic cohort, the majority had no allergy testing or negative testing. We found no evidence of a relationship between food allergy history and perioperative propofol reaction. We suggest multiply allergic and atopic patients may have a similar likelihood of propofol reaction as with other medications.

Research and quality improvement experience and knowledge: a nursing survey.

AIM: To assess nursing staff's background and research and quality improvement (QI) experience. BACKGROUND: In this corporation, participation in research and QI is encouraged, but little is known about nurses' experiences. METHODS: A web-based survey was distributed. Nursing staffs from an academic/teaching medical centre and other intra-corporation non-academic facilities were compared. RESULTS: Respondents included: 148 (52.9%) medical centre and 132 (47.1%) non-medical centre subjects. Medical centre respondents had a higher proportion previously engaged in research, currently engaged in research and previously engaged in QI. Productivity (grant, published and presented) was low for both groups but statistically lower for the non-medical centre group. Medical centre employees used research resources more often than the non-medical centre. Time was the most frequently mentioned barrier to participation in research and QI initiatives. CONCLUSIONS: A moderate proportion of respondents had research and QI experience, yet productivity and use of resources was low. Nurses at non-academically focused facilities were in most need of assistance. Familiarizing nurses with resources and providing protected time may increase productivity. IMPLICATIONS FOR NURSING MANAGEMENT: Developing an infrastructure to support nursing research is a worthy goal. Information about interest and experience of nurses can aid management in determining how to focus financial resources.

Right-sizing clinical education.

Frequently, education is prime when hospital administration is seeking opportunities to reduce the budget. Our hospital region faced that dilemma. This article discusses how our facility used management engineering to determine the number of education hours for each unit, based on specific negotiated criteria developed by a collaborative group, to answer the question "How many staff can one educator represent?"