International Patient Safety Goals for Peanut Allergy During Acute Asthma Exacerbation
The correct answer is Option C: Decrease mistakes due to miscommunication. This case directly involves a critical allergy discovered during handover—a high-risk communication transition point where miscommunication about peanut allergy could lead to fatal anaphylaxis, particularly given the patient's acute asthma exacerbation which significantly increases mortality risk from food-induced anaphylaxis 1, 2.
Why Communication Safety is the Priority
Handover represents the most dangerous communication transition in healthcare where critical allergy information must be accurately transmitted. The discovery of peanut allergy during handover indicates this information was either not communicated previously or was inadequately documented, creating immediate risk for:
- Fatal anaphylaxis from inadvertent peanut exposure during hospitalization, as peanuts cause the majority of fatalities from food-induced anaphylaxis 1
- Compounded risk from concurrent asthma, which is the strongest risk factor for fatal food-induced anaphylaxis 2
- Medication errors involving peanut-derived excipients or cross-contaminated pharmaceuticals 3
Why the Other Options Don't Apply
Option A (Preoperative Surgical Checklist) is irrelevant because this case involves acute medical management of asthma exacerbation, not a surgical procedure 3.
Option B (Identify patient correctly by using two identifiers) addresses wrong-patient errors but does not address the core safety issue here—the failure to communicate critical allergy information during care transitions 4, 5.
Critical Communication Elements Required
The following allergy information must be communicated during every handover:
- Specific allergen identification: Peanut allergy with documentation of previous reaction severity 1, 2
- Cross-reactivity risks: Potential reactions to tree nuts given common cross-reactivity patterns 6
- Emergency medication availability: Confirmation that two epinephrine autoinjectors are immediately accessible 1, 7
- Asthma control status: Current asthma severity as this dramatically increases anaphylaxis mortality risk 2
Immediate Safety Actions Post-Discovery
Upon discovering the peanut allergy during handover, the provider must:
- Document allergy prominently in all systems with severity classification and previous reaction details 1, 2
- Verify epinephrine availability with two autoinjectors at bedside (0.3 mg IM for adults) 1
- Review all current medications for peanut-derived ingredients or cross-contamination risk 3
- Communicate to dietary services with strict avoidance orders and cross-contamination precautions 1, 2
- Optimize asthma control as uncontrolled asthma contraindicates oral food challenges and increases anaphylaxis severity 2
Common Pitfalls in Allergy Communication
Delayed epinephrine administration has been implicated in contributing to fatalities from anaphylaxis, often because allergy information was not effectively communicated to responding providers 1. Many healthcare providers fail to recognize that:
- Oral tingling or mild symptoms can rapidly progress to life-threatening anaphylaxis within minutes 2
- Biphasic reactions occur in 1-20% of cases, requiring 4-6 hours observation even after initial symptom resolution 1, 7
- Asthma exacerbation itself can mask early anaphylaxis symptoms (wheezing, dyspnea), delaying recognition and treatment 3
Documentation Standards
Allergy documentation must include: