DOCTOR’S ORDER SHEET

DRUG ALLERGIES:
PENICILLIN ORAL CHALLENGE FOR PENICILLIN
DESENSITIZED PREGNANT PATIENT (06/2014) PATIENT IDENTIFICATION ROOM NO.

DATE

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TIME

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ORDERS FOR MEDICATION, DIET AND TREATMENTS

1. Diagnosis: Penicillin allergic, post penicillin desensitization – Oral Challenge Dose indicated
for treatment.
2. Admit to AICU or Labor & Delivery between 8AM – 10AM.
3. Notify Maternal Fetal Medicine MD, Anesthesiologist and AICU/L&D staff of patient’s arrival
on unit.
4. External fetal monitoring with strip if 23 weeks or greater gestation per L&D nurse. Continuous
cardiac monitoring per AICU staff.
5. NPO. Clear liquids may be given one hour after therapeutic dose. Regular diet 2 hours after
therapeutic dose.
6. IV of LR with 18 G cathlon. May use local anesthetic 1% Lidocaine (Xylocaine) at site. KO
rate unless otherwise specified.
7. Notify Maternal Fetal Medicine MD of any medication taken in the last 96 hours.
8. Obtain baseline vital signs, EKG strip, peak flow spirometry, and fetal monitor strip for 30 mins.
9. Medications readily available:
a) Epinephrine 1:10,000 injection (if required, initial dose to be 0.1 mg IV over 5 minutes)
b) Diphenhydramine (Benadryl) 50 mg IV Push
c) Hydrocortisone 100 mg injection (if required, dose may be administered IV Push over
30 seconds)
10. Administer Penicillin V Potassium 250 mg using 250 mg/5 ml oral solution as oral challenge
dose if less than 14 days have elapsed since last dose of Penicillin G Benzathine 2.4 million
units. Notify MD if other doses or other forms of penicillin were administered.
11. If allergic reaction observed, stop penicillin administration immediately and notify Maternal Fetal
Medicine MD.
12. Report any abnormal patient/fetal assessments to the physician immediately.
13. Observe for 30 minutes following completion of oral challenge dose and before beginning
intramuscular administration of penicillin.
14. Notify Maternal Fetal Medicine MD/Anesthesiologist of completion of oral challenge dose prior
to proceeding with therapeutic dose.
15. Continue with regular therapeutic doses as ordered per Maternal Fetal Medicine MD.
16. Observe the patient on continuous cardiac and fetal monitors for 24 hours after therapeutic
dose. (Continuous fetal monitoring if greater than 23 weeks gestation.)
17. Following physician order for discharge, review the following with the patient:
a. Post penicillin desensitization discharge instructions with follow-up appointment.
b. Give copy of Fetal Movement Counting Instructions if over 28 weeks.

06/2014 PENICILLIN ORAL CHALLENGE FOR PENICILLIN

DESENSITIZED PREGNANT PATIENT