I work for a visiting Home Health agency. Recently a big updo occurred because a patient was sent home on an IV antibiotic they never received in the hospital, but they also had a prescription for an EpiPen. Nursing was to administer the antibiotic and if there was a reaction we were to give the EpiPen and call nine-one-one. Nurses refused to take this case because they felt the patient should have had that antibiotic first in the hospital. DON and other management said we should take it anyways. Would you give the antibiotic or would you refuse it? Is this common practice?
Not without an ironclad policy and very clear informed consent for a patient who chooses this option. But more than likely, no.
Anaphylaxis is actually more likely with the second dose, not the first, and anaphylaxis can occur regardless of route, I've never seen anyone admitted to the hospital to be observed for their first few doses of PO antibiotics (or IV for that matter).
I would consider: your policy, patient Hx and condition, what particular AB being given, and why the order for the epipen (just precaution, pt with prior allergy to something similar?).
Anaphylaxis or any allergic reaction actually increases with use:
First-time exposure may produce only a mild reaction. Repeated exposures may lead to more serious reactions. Once a person has had an exposure or an allergic reaction (is sensitized), even a very limited exposure to a very small amount of allergen can trigger a severe reaction.
Allergic reactions: MedlinePlus Medical Encyclopedia
Our field nurses do first doses in the home with appropriate anaphylaxis orders. The hospital I liaise at's policy is that first doses cannot be administered in the home so when children come in for outpatient PICC lines, they are first dosed following the procedure and then our nurse goes out for the next dose.
Must Read Topics