Allergies/Intolerances, and Scope of practice.

The EMR we use currently groups allergies and intolerances together. This same system automatically D/C's any medications that are entered for a patient if they are listed in their allergies/intolerances. The problem with this is that when a patient says they have an allergy to Morphine because it makes them drowsy (not even an intolerance) then the standing MI protocol order for morphine gets blocked and we can't get it out of pyxis for that patient when are being treated for ACS, getting it straightened out can take a good 15 minutes.

Agree - this is unacceptable.

But the system can only block things based on someone, a health professional, having entered an allergy and apparently people are doing that without asking the appropriate questions when a patient indicates an "allergy."

Patient: "I'm allergic to Drug X."

Nurse: "What happens when you take Drug X?"

Patient:

"I get a rash" (allergy)

"My throat gets scratchy" (allergy)

"I get diarrhea" (possibly an intolerance -- more likely a common, not unexpected side effect of antibiotics, etc. that can potentially be managed if there isn't a good alternative to this particular med)

"I get a headache" (again - this symptom can probably be managed)

"My heart rate slows down" (intolerance)

etc.

Your EMR can probably be tweaked, but the process of entering "allergies" into the system should also be tweaked, IMO.

I can see how the "diagnosing" may come in to play. Perhaps you can solve this issue by having a protocol on the books, listing specifically what would be considered an allergy (rash, anaphylaxis, etc), and EXAMPLES ONLY of intolerances (since an inclusive list would be impossible to put together....I had a patient recently with epinephrine listed as an allergy...reaction? "Heart races"). This protocol could be approved by, say, your facility's medical director, or a physician board. That would be a one-time thing they would have to do, as opposed to separating allergies from intolerances for every patient, so they may be more agreeable to doing it. I would think that would cover the nurses legally from being accused of "diagnosing?"

I can see how the "diagnosing" may come in to play. Perhaps you can solve this issue by having a protocol on the books, listing specifically what would be considered an allergy (rash, anaphylaxis, etc), and EXAMPLES ONLY of intolerances (since an inclusive list would be impossible to put together....I had a patient recently with epinephrine listed as an allergy...reaction? "Heart races"). This protocol could be approved by, say, your facility's medical director, or a physician board. That would be a one-time thing they would have to do, as opposed to separating allergies from intolerances for every patient, so they may be more agreeable to doing it. I would think that would cover the nurses legally from being accused of "diagnosing?"

When the proposal first came out, a 'help screen' with an algorithm to help differentiate allergies and intolerances was part of the plan. Unfortunately it didn't seem to help.

Agree - this is unacceptable.

But the system can only block things based on someone, a health professional, having entered an allergy and apparently people are doing that without asking the appropriate questions when a patient indicates an "allergy."

Patient: "I'm allergic to Drug X."

Nurse: "What happens when you take Drug X?"

Patient:

"I get a rash" (allergy)

"My throat gets scratchy" (allergy)

"I get diarrhea" (possibly an intolerance -- more likely a common, not unexpected side effect of antibiotics, etc. that can potentially be managed if there isn't a good alternative to this particular med)

"I get a headache" (again - this symptom can probably be managed)

"My heart rate slows down" (intolerance)

etc.

Your EMR can probably be tweaked, but the process of entering "allergies" into the system should also be tweaked, IMO.

Tweaking how the allergies and intolerances are entered is what we are trying to do, the problem we are running into is that there are nurses who don't feel comfortable entering reactions as either allergies or intolerances, but instead want to continue entering medications as a general "allergy/intolerance" single group, which often also includes expected minor side effects.

Tweaking how the allergies and intolerances are entered is what we are trying to do, the problem we are running into is that there are nurses who don't feel comfortable entering reactions as either allergies or intolerances, but instead want to continue entering medications as a general "allergy/intolerance" single group, which often also includes expected minor side effects.

This is, well ... unfortunate.

It isn't "diagnosing" to indicate that a patient has indeed experienced one of the multiple expected side effects listed in the medication's package insert or any drug guide.

I would guess that your system is equally cumbersome for physicians -- get them on board with the redesign.