Rapid Drug Desensitization Procedure Note

Procedure Date: [Procedure date]

Start Time / Stop Time: [Start time] / [Stop time]

Location: [infusion center / inpatient unit / ICU / procedural area]

Ordering Service: [Ordering service]

Performing Clinician: [Name, credentials]

Nursing: [Name(s)] (Include only if 1:1 monitoring performed)

Procedure Summary

[1–3 sentence summary including: drug desensitized (generic name; brand for biologics), route, target dose, protocol type, and outcome (completed vs aborted; breakthrough reactions and management if any)]

Indication & Clinical Context

[Underlying disease and therapeutic intent] [Reason desensitization is necessary and why alternatives are not acceptable] [Single dose vs repeating treatment course; note that each exposure requires desensitization pathway if repeating]

Index Hypersensitivity Reaction History

• Culprit drug and exposure details: [Drug; date; cycle/dose number; route; dose]
• Time to onset: [Minutes/hours/days from exposure]
• Clinical phenotype: [immediate / delayed] [infusion reaction / anaphylaxis]
• Signs and symptoms by system: [Cutaneous] [Respiratory] [Cardiovascular] [Gastrointestinal] [Neurologic/other]
• Objective findings at the time: [Vitals, SpO2, wheeze/stridor, hypotension or other hemodynamic changes]
• Treatments required: [Epinephrine (dose/route)] [Antihistamines] [Corticosteroids] [Bronchodilators] [Fluids] [ED/ICU care]
• Severity grading: [Grade] per [named grading system]
• Anaphylaxis criteria met: [Yes / No / Uncertain]
• Prior desensitization attempts: [None / details of prior attempts and outcomes]

(If details unavailable, document source limitation and record minimum known elements: drug, general reaction type, severity.)

Allergy Evaluation & Risk Stratification

(Include this section only if testing was performed. If no testing performed, omit this section entirely and add the following line in Pre-Procedure Assessment instead: "No validated allergy testing performed for this agent; proceeding based on clinical history and risk-benefit assessment.")

• Skin testing: [Agent(s), concentrations, controls, interpretation, date]
• In vitro testing: [Test type, agent, result, date] (Include if performed)
• Baseline serum tryptase: [Value, unit, date] (Include if obtained)
• Mechanism assessment: [IgE-mediated / cytokine-release / non-immune / indeterminate] (Include only if explicitly determined)

Pre-Procedure Assessment

Contraindication Screen:

• Severe cutaneous adverse reactions (SJS/TEN, DRESS, AGEP): [Yes / No / Unknown] [Details/mitigation if applicable]
• Vasculitis or serum sickness-type reaction: [Yes / No / Unknown] [Details/mitigation if applicable]
• Drug-induced organ involvement: [Yes / No / Unknown] [Details/mitigation if applicable]
• Beta-blocker use: [Held / Continued] [Agent, timing, rationale]
• ACE-inhibitor use: [Held / Continued] [Agent, timing, rationale]
• Asthma control status: [Well-controlled / Partially-controlled / Uncontrolled] [Recent symptoms, peak flow if relevant]
• Significant cardiovascular disease: [Yes / No / Unknown] [Details and implications]

(Use "Unknown" rather than "No" if uncertain; document mitigation measures for unknowns.)

Baseline Assessment:

• Vitals: HR [value] | BP [value] | RR [value] | SpO2 [value] | Temp [value]
• Focused cardiopulmonary exam: [Key findings]
• Peak flow: [Value and % predicted] (Include if per protocol)

Vascular Access: [Type], [Gauge], [Location], patency confirmed

Emergency Readiness: IM epinephrine, antihistamines, bronchodilators, corticosteroids, IV fluids, code cart available and confirmed

Consent: [Verbal / Written] consent obtained from [patient / surrogate]. Risks discussed including breakthrough reactions, anaphylaxis, possible epinephrine use, and care escalation. Benefits and alternatives reviewed. Patient informed that desensitization confers temporary tolerance only.

Pre-Procedure Verification: Correct patient (two identifiers), correct drug and formulation, correct route and target dose, correct protocol version confirmed. Emergency plan reviewed; team roles assigned.

Premedication

(Name institutional protocol if standard regimen used; list individual medications actually administered.)

Medication	Dose	Route	Time Given	Notes
[Name]	[Dose]	[Route]	[Time]	[Protocol name or additional details]

Held medications relevant to reaction management: [Medication, timing held, rationale] (Include if applicable)

Protocol Specification

• Ordered target dose: [Dose (mg) and calculation basis]
• Diluent and total volume: [Diluent type] [Total volume per bag/solution]
• Number of bags/solutions and concentrations: [Bag 1: concentration] [Bag 2: concentration] [Bag 3: concentration]
• Pump programming approach: [Rate-based / Dose-based]
• Independent double-check performed by: [Name/Role] and [Name/Role]
• Verification: Sum of planned step doses equals target dose confirmed

Stepwise Dosing Table

(Always include even if procedure aborted early. Keep planned protocol visible; document deviations in Actual/Status/Comments fields without overwriting the plan.)

Step #	Bag #	Concentration	Planned Rate	Planned Duration (min)	Planned Step Dose (mg)	Planned Cumulative Dose (mg)	Actual Start	Actual Stop	Status	Comments
[1]	[#]	[Concentration]	[Rate]	[Duration]	[Dose]	[Cumulative]	[Time]	[Time]	[completed / paused / repeated / skipped]	[Notes]
[2]	[#]	[Concentration]	[Rate]	[Duration]	[Dose]	[Cumulative]	[Time]	[Time]	[completed / paused / repeated / skipped]	[Notes]

(Add rows for all planned steps. Continue table as needed.)

Protocol modifications: [Modification(s) made during procedure, timing, step affected, and rationale] (Include only if protocol was modified mid-procedure)

Intra-Procedure Course

Monitoring performed: [Continuous monitoring type (pulse oximetry, telemetry)], vitals q[frequency], [continuous nursing presence: Yes / No]

Clinical course summary: [Summary of patient status during procedure] (If asymptomatic: "Patient tolerated all steps without symptoms or objective reaction signs.")

Breakthrough Reactions

(Include this subsection only if any symptoms occurred during the procedure, even if mild. Document each event as a numbered entry. Omit entirely if no reactions occurred.)

1. Timestamp and protocol position: [Time], Step [#], Bag [#], Rate [value] at onset

   Clinical features: [Patient-reported symptoms (use direct quotes for subjective sensations)] [Objective findings: rash description, wheeze, angioedema, vital sign changes, SpO2]

   Severity grade: [Grade] per [named grading system]; Anaphylaxis criteria met: [Yes / No]

   Immediate actions: Infusion [stopped / paused] at [time]; [Supportive measures: O2, positioning, fluids]

   Medications administered: [Drug, dose, route, time, response] (If epinephrine given, document dose, route, and patient response)

   Escalation: [Remained in unit / RRT called / ED transfer / ICU transfer]

   Restart decision: Infusion [resumed at step # / not resumed]; [Protocol modifications if any]

   Post-event reassessment: [Repeat vitals and exam]; Time to return to baseline: [duration]

Procedure Completion

[Completed / Aborted (reason if aborted)]. Total dose delivered: [mg] ([%] of intended dose). Total infusion time: [duration]. Final vitals: [HR, BP, RR, SpO2]. Final exam: [Key findings]. [Complications including delayed reactions during observation, or "No complications."]

Post-Procedure & Discharge

Observation: [Duration] post-procedure monitoring in [location]

Patient Instructions: Delayed reaction warning signs reviewed; advised to seek care for [specific symptoms]. Contact information provided. [Medication instructions including antihistamine continuation, driving precautions if sedating medications given]

Follow-Up: [Next planned desensitization date/cycle if applicable] [Allergy clinic follow-up plan]

Allergy Documentation: EHR allergy record updated to reflect desensitization performed; tolerance documented as conditional on controlled administration

Handoff: [Receiving clinician/unit] [Key safety considerations: biphasic reaction monitoring, do not re-dose outside protocol] (Include if applicable)