What is the best international safety procedure for a patient with an acute asthma exacerbation and a newly discovered peanut allergy?

Best International Safety Procedure for Acute Asthma Exacerbation with Newly Discovered Peanut Allergy

The correct answer is B - Identify the patient correctly by using two identifiers, as this is the fundamental international patient safety procedure that must be implemented during handover to prevent medication errors, ensure proper allergy documentation, and maintain continuity of care for this high-risk patient with both acute asthma and peanut allergy.

Rationale for Patient Identification as Priority

Correct patient identification using two identifiers is the cornerstone of international patient safety protocols that directly impacts morbidity and mortality in this clinical scenario. During handover, misidentification could lead to:

• Administration of wrong medications that could trigger anaphylaxis in a patient with documented peanut allergy 1
• Failure to document critical allergy information in the correct patient's medical record 1
• Inability to access emergency medications (epinephrine autoinjectors) if patient identity is confused 1

Critical Safety Considerations in This Clinical Context

Immediate Risk Assessment

This patient faces dual life-threatening risks that make correct identification paramount:

• Acute asthma exacerbation requiring immediate bronchodilator therapy with albuterol and potential corticosteroids 1
• Peanut allergy with risk of anaphylaxis, particularly dangerous given coexisting asthma 2, 3

Asthma is a major risk cofactor for anaphylactic deaths in children with peanut allergy, with patients having severe asthma showing 6.8-fold increased risk of life-threatening bronchospasm 3. This makes accurate patient identification and allergy documentation critical to prevent fatal outcomes 2.

Why Other Options Are Insufficient

Option A (Preoperative Surgical Checklist) is inappropriate because:

• This patient is experiencing an acute medical emergency, not undergoing surgery 1
• Surgical checklists do not address acute asthma management or anaphylaxis preparedness 1

Option C (Decrease mistakes due to miscommunication) is important but secondary to:

• Patient identification must occur FIRST before any communication about allergies can be meaningful 1
• Without correct identification, even perfect communication about allergies may be applied to the wrong patient

Essential Clinical Actions Following Correct Identification

Immediate Allergy Documentation

Once patient identity is confirmed with two identifiers:

• Document peanut allergy prominently in all medical records and allergy alerts 1
• Ensure epinephrine availability - patients with peanut allergy must have immediate access to epinephrine autoinjectors (0.01 mg/kg IM or 0.15 mg autoinjector for children) 1
• Verify no peanut-containing medications or excipients in any prescribed treatments 4, 5

Asthma Exacerbation Management

Following correct patient identification, treat the acute asthma exacerbation according to international guidelines:

• Assess severity using pulse rate, respiratory rate, degree of breathlessness, use of accessory muscles, wheezing, and oxygen saturation (target >90-92%) 1
• Administer bronchodilators: Albuterol (salbutamol) via inhaler or nebulization (0.15 mg/kg every 20 minutes × 3 doses, minimum 2.5 mg per dose) 1
• Add ipratropium bromide for moderate to severe exacerbations in conjunction with albuterol 1
• Provide oxygen supplementation for moderate to severe exacerbations 1
• Consider corticosteroids: Oral or IV corticosteroids for moderate to severe exacerbations 1

Critical Safety Warning

Uncontrolled asthma is an absolute contraindication to oral immunotherapy for peanut allergy 1. This patient's acute asthma exacerbation must be stabilized before any consideration of long-term peanut allergy management strategies 1.

Handover Communication Protocol

After establishing correct patient identity with two identifiers:

• Communicate both diagnoses clearly: Acute asthma exacerbation AND peanut allergy 1
• Specify emergency medication availability: Location of epinephrine autoinjectors and albuterol inhalers 1, 6
• Document ongoing eosinophilic airways inflammation risk: Patients with peanut allergy and asthma history may have persistent airway inflammation even when asymptomatic 2
• Alert receiving team to increased anaphylaxis risk given coexisting asthma 2, 3

Common Pitfalls to Avoid

• Never assume allergy information transfers automatically during handover without verifying patient identity first 1
• Do not delay epinephrine administration if anaphylaxis symptoms develop while managing asthma - epinephrine is first-line treatment and safe to administer with bronchodilators 1
• Avoid relying solely on antihistamines for allergic reactions in patients with peanut allergy and asthma, as severe reactions can progress rapidly 1
• Do not assume "outgrown asthma" means no risk - these patients often have ongoing eosinophilic inflammation and elevated FeNO levels 2