Immunotherapy Safety for the Primary Care ... - U.S. Coast Guard

Allergy immunotherapy administration by licensed nursing staff
By Arline M. Gerard, RN, Kaiser Orange County, CA
It is within the scope of practice of licensed nurses to administer allergy immunotherapy medications for
the purpose of treatment of allergy patients.
Authority for nurses to administer medications derives from varying sections of their states’ Nurse
Practice Act (NPA). Most states place few limits on the type of medication or route of administration;
there is often only a requirement that the drug be ordered by one lawfully authorized to prescribe it. Other
relevant sections of some NPA’s do impose additional requirements, but these generally do not pertain to
allergy immunotherapy extract vaccines. Specifically, the nurse should be competent to perform the
function of administering medications, and this task must be performed in a manner consistent with the
standard of practice expected of a diligent nurse, in that state.
In administering medication/extracts for treatment of allergy patients, the nurse is required to have the
same knowledge and skills as for any other medication that she/he administers. This knowledge base
includes, but is not limited to:
• Effects of the medication/extract
• Potential side effects of the medication/extract
• Contraindications for the administration of the medication/extract
• Amount of the medication/extract to be administered
• Dilution of the medication/extract to be administered
The requisite skills include the ability to competently and safely administer the medication/extract by the
specified route, anticipate and recognize potential complications of the medication/extract, recognize
emergency situations, and institute emergency procedures. Thus, the nurse would be held accountable for
knowledge of the medication/extract and for ensuring that the proper safety measures are followed.
As of March 2003, safety considerations for allergy immunotherapy administration include the standards
embodied in the Practice Parameters. These national standards were issued jointly by the American
Academy of Allergy, Asthma & Immunology with the American College of Allergy, Asthma &
Immunology. The Practice Parameters should be consulted in establishing and maintaining allergy office
policies and procedures.
The nurse administering allergy immunotherapy should conduct a brief nursing assessment to determine
that administration of the medication/extract is in the patient's best interest, for that visit. The nurse would
also ensure that all safety measures are enforced, including back-up personnel skilled and trained in
airway management, resuscitation and emergency intubation, should complications occur. Nurses
managing the care of patients receiving allergy immunotherapy shall expect the patient to wait, post
injection. The nurse should not engage in tasks that would seriously compromise monitoring of the
patient by the nurse. The nurse must have knowledge of signs and symptoms of a reaction to the
medication/extract, and must be empowered to give epinephrine and other treatments, immediately, when
determined to be necessary.
A nurse is held accountable for any act of nursing provided to a patient. The nurse has the right and
obligation to act as the patient's advocate by refusing to administer or continue to administer any
medication/extract not in the patient's best interest; this includes medication/extracts which may cause the
patient to have an anaphylactic event, especially when given in error. Basic immunotherapy forms