Overview of the Training by the Nurse Trainer
Day 1 – First Afternoon
- Introduction of allergy to the office staff
- Make sure all supplies and extracts are inventoried, logged (LOT #), and put away for convenient access
- Discuss USP 797 Compounding Guidelines and the need to maintain a sterile environment for filling of trays, mixing dilutions, and making individual patient treatment vials
- Setup prick puncture testing tray with allergens in the order they are in on the test form
- Review proper patient selection, contraindications to testing, and patient preparation for testing
- Discuss different types of allergy testing and treatment – overview of Prick, Intradermal, and In-Vitro testing
- Demo/practice the prick and ID testing with saline on each other (type of testing being used in clinic)
- If sufficient time, demonstrate proper mixing and begin making intradermal allergen test dilutions
Day 2 – Morning
- Finish preparing all *intradermal allergen test dilutions in phenolated saline as well as the treatment dilutions in 50% glycerine thereby creating a test board and a separate treatment board (*a math short cut can be used for making just the # 2, the # 5, and the # 6 dilutions only for testing)
- Review proper expiration dating for all compounded vials based on current industry standards
- Review and discuss testing process, need for controls, and accuracy in the process with proper documentation
Day 2 – Afternoon
- Practice patient preparation (explanation of process, obtaining history, consent, etc.) and testing on volunteer test patients (real patients if at all possible pre-selected by the site physician)
- Perform prick puncture testing on several patients and only do intradermal testing on those contemplating immunotherapy / trainer does initial testing with trainee observing – all per A.A.A.A.I and A.A.O.A. guidelines
- Discuss outcomes and possible suggested treatment approaches (SCIT, SLIT, and OMIT)
- Provide and explain patient education to patients tested with regard to avoiding allergens, medication use, and following instructions for immunotherapy
Day 3 – Morning
- Review test results and cover dose calculation & formulation of treatment vials for all three immunotherapy approaches – review forms to use for each approach and complete appropriate forms
- Additional practice patient prep & testing on volunteers and/or live patients with trainee performing all testing and trainer in observation and correction/encouragement mode
Lunch and Learn with the Physicians, Direct Allergy Nurse, and Office Staff – Complete Overview of Program
Day 3 – Afternoon
- If time allows, additional testing done by new staff member
- New staff member discusses results with patient, patient education, etc. just as they will be doing in clinic
- Review test results, allergen selection based on history, and writing of formulas based on results
- Review process, set up, and prepare patient specific treatment sets
Day 4- Morning
- Discuss and review previous days testing and vial formulation
- Review immunotherapy dosing and proper documentation
- Review dosage decisions and adjustments
- Discuss how to properly give subcutaneous injections and give several subcutaneous injections
- Cover emergency protocols for adverse patient reactions in detail