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/depts/uwhealth/ambulatory-education/checklists/resources/Allergy-Checklist.pdf

201712353

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100

UWHC,UWMF,

Learning and Development,

Departments & Programs,UW Health,Ambulatory Education,Checklists - Core and Department Specific,Resources

Allergy

Allergy - Departments & Programs, UW Health, Ambulatory Education, Checklists - Core and Department Specific, Resources



Allergy Clinical Training Checklist

Name: ___________________________ ID: _________ Clinic: ______________ Start Date: ________ Due Date: ________
Area of Orientation

Discussed/
Observed
(D/O)
Preceptor’s
Initials
Date
Completed
Employee is able to gather data relevant to the following (Signs &
Symptoms, onset, interval, location & severity of):

ξ Allergic Rhinitis - drainage - clear or colored
ξ Sinusitis - drainage color, facial pain, fatigue, fever, tooth pain
ξ Asthma - wheezing, chest tightness, dyspnea, cough
ξ Urticaria - generalized, splotchy, red, raised, pruritic
ξ Food Allergy - urticaria, swelling, nausea/vomiting, diarrhea
ξ Bee Sting Allergy – LOC, dyspnea, urticaria, local swelling
ξ Anaphylaxis - LOC, throat tightness, dyspnea, hypotension
ξ Atopic Dermatitis - red, blistering, oozing, scaly, brownish, thickened
ξ Medication Allergy - What medication(s), signs and symptoms
Patient History - to include:
ξ Familial - parents, siblings, children, pregnancy
ξ Environmental - work outdoors, sports, smoker, pets, plants
ξ Able to elicit patient's expectations of medical care
ξ Able to determine patient's knowledge level/deficit and ability to
understand

ξ Able to identify cultural practices related to care
ξ Able to elicit info regarding relationships with significant others
Health Education - Employee demonstrates knowledge & can discuss:
ξ Prep prior to New Patient appt - no AH 5 days prior, off beta blockers,
asteline/astepro, tricyclic antidepressants

ξ Application of Skin Tests –percutaneous/ID - 10-15 min between,
red/itchy, measure wheal/flare

ξ Peak Flow Meter - Red, Yellow, Green zones
ξ Metered Dose Inhalers & Aerochambers - Albuterol, Maxair

V 12/13/2017 Draft Ambulatory RN Orientation Review
2
Area of Orientation

Discussed/
Observed
(D/O)
Preceptor’s
Initials
Date
Completed
ξ Nasal Corticosteroids use & technique - Flonase, Nasacort, Rhinocort
ξ Corticosteroids - inhaled - Advair, Flovent, Pulmicort
ξ Antihistamines – 2nd Generation (with/without decongestant) Claritin,
Allegra, Zyrtec)

ξ Leukotriene Modifiers - Singulair
ξ Environmental Control - Mites, Molds, Pets
ξ Immunotherapy - reactions, 8-12 mo. build, 3-5 yrs on shots, 30 minute
wait

ξ Epi Pen Training with return demonstration from patient/parents - consent
form signed (Epipen Jr. vs. regular Epipen)

Employee demonstrates knowledge of basic Patient Handouts
ξ Blue Patient Folder - Inhalant Allergy
ξ Green Patient Folder - Food Allergy
ξ Yellow Patient Folder - Latex Allergy
ξ Red Patient Folder - Venom Allergy
ξ Patient Catalog - home products - mattress covers, air filters
ξ Neti-Pot - ENT Sol
ξ Immunotherapy – Allergy Injection Program Sheets, Consent Forms
ξ Omalizumab(Xolair)- Patient Information, Consent Forms
Employee demonstrates knowledge of basic Clinical Training Areas
ξ Dr. Biagtan- Rms 4, 5, 6, History sheet, blue flag, ACT
ξ Dr. Puchner – Rms 1, 2, 3, History sheet, prep chart w/forms upon
patient’s arrival, green flag

ξ Dr. Ritter- Rms 10, 11, 12, History sheet, red flag
ξ Dr. Healy - Rms 7, 8, 9, History sheet, green flag, ACT
ξ Networking – packing/set-up/restocking supplies
ξ Yellow flag- nurse is testing or in with that patient
ξ All flags out- reaction or challenge
ξ Understand hand off of injection room pt reaction to back clinic RN
Employee demonstrates knowledge of Consults and Referrals

V 12/13/2017 Draft Ambulatory RN Orientation Review
3
Area of Orientation

Discussed/
Observed
(D/O)
Preceptor’s
Initials
Date
Completed
ξ Nutritional Specialists
ξ Smoking Cessation
ξ ENT
ξ Dermatology, Pulmonary, Voice Clinic, Sleep Clinic
Demonstrate competence in counseling/providing resources
ξ Refer to specialty support groups - Food Allergy & Anaphylaxis Network
ξ Obtain prior authorization for medications
ξ Patients who need financial assistance should contact Patient Relations
ξ Be able to speak with pharmaceutical representatives
Employee demonstrates knowledge in Equipment & Supplies
ξ KoKo Pneumotach – calibrate, admin lung function with reliable coaching
ξ Laptop Spirometry - calibrate, admin lung function with reliable coaching
ξ Monitor expiration dates on meds at nurses station & travel boxes
ξ Prepare Skin Test Puncture Trays and ID syringes
Procedures- Demonstrate competence to assist/set-up/patient care/follow-up
ξ Nebulizer Treatment
ξ Administer O2
ξ Administer Puncture Skin Tests
ξ Administer Intradermal Skin Tests
Diagnostic/therapeutic tests- Demonstrate competence to assist/set-up/patient
care/follow-up

ξ Computerized Baseline Spirometry
ξ Bronchospasm Evaluation (BSE)
ξ Oral Challenge - Foods (egg, milk, peanut) Medications (ASA, PCN)
ξ Application of Skin Tests (VS prior to tests) for Inhalants
ξ Food - prepared skin test material & fresh food (dilute material)
ξ PCN percutaneous/ID testing
ξ Venom - HB, YJ, YH, WFH, Wasp-percutaneous/ID
ξ Ice Cube Challenge
ξ Latex Skin Tests

V 12/13/2017 Draft Ambulatory RN Orientation Review
4
Area of Orientation

Discussed/
Observed
(D/O)
Preceptor’s
Initials
Date
Completed
ξ Local Anesthetics - caines
ξ T.R.U.E. Test Patches
ξ Other patch tests – cosmetics, foods, etc
ξ Basic Respiratory Care
Outreach/Travel
ξ Prepping bins for each MD, medication bin, general bin
ξ Prepping cooler with contents from injection room refrigerator
ξ Understanding all items needed for travel
ξ Laptop/koko use and passwords
ξ Restocking bins
Employee demonstrates knowledge of Medication Administration
ξ Understands the following drug compatibilities
ξ Demonstrates use of inhalers/nasal sprays
ξ Verbalizes the appropriate dose, mechanism, side effects of medications
o Epinephrine 1:1000
o Administration of Bottled Antigen
o Omalizumab/Nucala
o Albuterol unit dose per aerosol treatment
o Ipratropium (dilute in NS) unit dose per aerosol treatment
o Benadryl IM - amp or vial
o Prednisone tabs 5mg, 10mg, 20mg
o Influenza Vaccine/ Pneumonia vaccine 23/13
Demonstrate knowledge of:
ξ Order Entry in Health Link - Charging for procedures & supplies
ξ Laboratory Orders- in computer; send patient with lab sheet (with label
and directions)

ξ Scheduling Pt with Imaging – in Health Link; send patient with lab sheet
(with label and directions)

Provides URGENT Patient Care – Employee is able to:
ξ Crash Cart awareness/checkoff daily
ξ Initiates EKG monitoring (when indicated)

V 12/13/2017 Draft Ambulatory RN Orientation Review
5
Area of Orientation

Discussed/
Observed
(D/O)
Preceptor’s
Initials
Date
Completed
ξ Initiates Defibrillation (if indicated)
ξ Appropriately care for patient requiring an EKG interpretation
ξ Appropriately care for patient requiring anti-arrhythmic medication
Injection Room
ξ Understands forms/paperwork/refills (xolair, necala, antigen, venom)
ξ Understands injections (antigens, venoms, xolair, nucala, vaccines)
ξ First Injection- sign up, commitment, consent, teaching, build, reactions,
epi-pen use, 6-10 mo build, 3-5 year therapy, wait time

ξ Prepping Injection Room evening/morning duties
ξ Charging injections in EPIC (antigen, venom, xolair, nucala, vaccine)
ξ Venom dilution, xolair prep and admin
Antigen Lab
ξ Understands how antigens are made and resources available in lab
ξ Understands how to check new paperwork and antigens into inj room
Downtime
ξ Restock rooms, folders, ID’s, general stock
ξ
ξ
ξ
ξ