A nurse manager is preparing to complete staff performance appraisals. Which of the following principles should the nurse manager consider when completing the appraisals?

Near miss:

• Incident Report 1: The nurse identified the client's allergy before administering azithromycin, preventing an adverse reaction. Holding the medication and notifying the provider ensured patient safety, making this a near miss rather than an adverse event.

Adverse Event:

• Incident Report 2: The client did not receive prescribed prophylactic antibiotics during labor, leading to neonatal sepsis. The lack of antibiotic administration increased the risk of serious complications, making this an adverse event with potential long-term consequences.

• Incident Report 3: A tenfold dosing error led to the administration of 60 units instead of 6 units of insulin, resulting in severe hypoglycemia and unresponsiveness. This critical medication error placed the client at significant risk for neurological damage or death, classifying it as an adverse event.

• Incident Report 4: A critically low platelet value was reported but not communicated to the provider, delaying intervention and leading to a coma. The failure to act on critical lab results contributed to a preventable deterioration in the client’s condition, making this an adverse event.

• Incident Report 5: Despite being identified as a fall risk, the client sustained a fall due to a malfunctioning call bell, leading to an injury. The failure to address the defective equipment compromised patient safety, making this an adverse event that could have been prevented.

A. "I have a severe allergy to amoxicillin." A severe allergy to amoxicillin suggests a potential cross-reactivity with ceftriaxone, as both belong to the beta-lactam antibiotic class. While cross-reactivity between penicillins and cephalosporins is lower with third-generation cephalosporins like ceftriaxone, a history of severe allergic reactions, such as anaphylaxis, warrants consultation with the provider before administration.

B. "I get sick when I take diuretics." Adverse effects from diuretics do not typically indicate a contraindication to ceftriaxone. While diuretics like furosemide can interact with aminoglycosides to increase nephrotoxicity, ceftriaxone does not share this risk. Monitoring for individual tolerances is important, but this statement does not require holding the medication.

C. "I have a history of hearing problems." Ceftriaxone is not associated with ototoxicity, unlike aminoglycosides or vancomycin. A history of hearing problems does not necessitate withholding the medication, though the nurse should monitor for any new or worsening symptoms if concurrent ototoxic medications are prescribed.

D. "I take prednisone for my asthma." Corticosteroid use does not directly contraindicate ceftriaxone administration. While prolonged corticosteroid therapy may increase the risk of infections or mask symptoms of an allergic reaction, it does not warrant holding the antibiotic. The nurse should continue routine monitoring but can safely proceed with administration.