Healthservices.eku.edu

EASTERN KENTUCKY UNIVERSITY
Dear Dr. __________________________, We at Eastern Kentucky University Student Health Services are happy to administer allergy injections to your patient,_____________________. We must, however, clarify the conditions under which these shots are given. The serum, upon receipt by SHS, is immediately refrigerated. When the patient presents at our clinic, vital signs specified by his/her allergist are obtained. After ensuring that a physician is immediately available if needed, serum is drawn up by an RN or CMA (according to dosing chart provided by your office), and administered using aseptic technique. The patient is then observed for at least 20 minutes for any adverse reaction, and discharged only after inspection of the injection site, and general evaluation of the patient, by an RN or a CMA reveals no problems. In the event of an adverse reaction, we have available at our clinic sq epinephrine 1:1000 dilution, IM Benadryl, IM steroids, and supplemental oxygen via nasal cannula. We do not have the capability for IV access, nor airway management via intubation. We rely on our local EMS for emergency transport to our local, full service hospital emergency room; and their response time so far has been exceptionally good. You know your patients best; should you feel that your patient requires more than this, it would seem appropriate that he/she receive his/her shots at a facility better able to meet his/her needs. We will be glad to forward the medical records and the serum to the new facility of the patient’s choosing. We receive sera for administration, accompanied by instructions, from allergists and ENT physicians from all over the nation. Often there is wide variation in the instructions for managing adverse reactions. While one is satisfied with sq epinephrine for wheezing and shortness of breath, another requires IV aminophylline. Our limited resources restrict our ability to provide everyone with everything. We have, therefore, settled on these measures as the most reasonable for our situation. If you feel that our facility will adequately meet the needs of your patient, please indicate your consent by your signature below the following statement, and return to us. I have read the procedure and protocol governing the administration of allergy shots at Eastern Kentucky University Student Health Services, and find them acceptable for my patient, ________________________. Any future, dated, standard material calling for intervention greater than can be provided at EKU SHS can be disregarded. Printed Name of Doctor: ________________________________ Signature:____________________________ Date Signed: __________________________ Thanking you for your assistance, Pradeep Bose, M.D. Director, Student Health Services EASTERN KENTUCKY UNIVERSITY
To: Allergy Office From: Pradeep Bose, M.D., Director Re: Policy on Allergy injections for students Date: June 3, 2005  Allergy injections are given by Registered Nurses and Certified Medical Assistants trained in the procedure, at the Student Health Services facility, from 8:30 am to 11:30 am and 1:00 pm to 4:00 pm, Monday through Friday when school is in session.  A Student Health physician must be in the building when the injections are given.  Detailed instructions from allergist must be on file in the student’s chart before injections can be given. This would include dosing schedule and instructions from allergist regarding any reactions.  First injections, when initiating therapy, are not given at SHS.  At the beginning of each school session, and following school breaks, documentation of up-to-date injections must be presented to SHS staff.  Students receiving allergy shots are required to remain at SHS for twenty minutes following injections, or longer if requested by allergist, and have injection sites checked by RN or CMA before leaving. Failure to do so will result in termination of allergy extract administration services.  Each student is responsible for ordering and maintaining his or her own supply of allergy extract.  Allergy extracts should not be mailed to Student Health Services. They should be brought in by the
The RN or CMA may find it necessary to call an allergist’s office for instructions regarding specific
situations which may arise from time to time. Verbal orders cannot be accepted; all instructions must be
in writing, and may be transmitted by fax or regular mail. We appreciate your cooperation and assistance
in this regard.
Our fax number is (859) 622-1767.
Our mailing address is:
Student Health Services, EKU
Rowlett 103
521 Lancaster Ave.
Richmond, KY 40475

Source: http://www.healthservices.eku.edu/sites/healthservices.eku.edu/files/files/Allergy%20Dr%20%20Consent.pdf