Page Section: Centre Content Column
Identification of penicillin allergy prior to prescribing medication (12HDC01062)
Download Identification of penicillin allergy prior to prescribing medication (12HDC01062) (PDF 37Kb)
(12HDC01062, 30 May
Doctor in urgent care ~ Accident and medical clinic ~
Emergency care ~ Penicillin allergy ~ Right 4(1)
A 60-year-old man attended an accident and medical clinic for
two infusions of antibiotics, having been referred following his
discharge from hospital with cellulitis in his leg.
The man had an allergy to penicillins, which had previously been
entered into his records at the clinic. This meant that a
medication alert would "pop up" in the patient management software
(PMS) each time a doctor prescribed medication for him.
A doctor assessed him, and an intravenous (IV) dose of cefazolin
was administered by a nurse on the doctor's instruction. The man
experienced no adverse reaction and was asked to return to the
clinic the following day for review.
The following day the man returned to the clinic and was again
seen by the doctor who considered that the man's leg appeared to be
deteriorating. The doctor administered 1g of oral flucloxacillin, a
penicillin, to the man without prescribing it using the PMS, and so
was not alerted to his allergy by the PMS. A further dose of IV
cefazolin and probenecid was administered by a nurse on the
The doctor typed up her handwritten consultation notes, but did
not prescribe any of the medication using the PMS. She then left
the clinic. A nurse subsequently asked another doctor to prescribe
the cefazolin and probenecid, which he did, but he did not
prescribe the flucloxacillin because he was not aware that the
first doctor had administered it.
Early the following morning the man experienced symptoms of an
allergic response, so at around 2.15am he returned to the clinic.
The second doctor assessed the man as suffering from an allergic
reaction, likely due to the oral flucloxacillin dose he had been
given the previous evening. He decided to refer the man to hospital
for observation, where he was kept overnight to ensure the
resolution of the allergic reaction.
It was held that the first doctor missed several opportunities
to become aware of the man's allergy, for example reading the notes
or asking him questions. Furthermore, she should have complied with
the clinic's medication protocol and prescribed the flucloxacillin
using the PMS system.
It was the first doctor's responsibility to ask the man whether
he had any allergies, check the PMS system, and/or appropriately
prescribe the medication she provided to him. By failing to do so,
she did not provide services with reasonable care and skill and
breached Right 4(1) of the Code.
Comment was made regarding the second doctor that, although it
was not unreasonable for him to rely on information provided by the
nurse, best practice would have been to review the man's