How to handle certain patient "allergies"

[SubSippi]

I've been working for a few months, and I have so many questions, most of which are answered by my coworkers. Sometimes, though, I feel the need to get some outside opinions, and this is one of those times...

When a patient tells us about an allergy, we ask what happens when they take the medication...finding out if it's a true allergy. Often, the patient will say that it made their stomach hurt, or made them feel dizzy, or something like that...even when that happens, we still list it as an "allergy," even though the patient didn't have a true allergic reaction.

With these medications, I have seen several times that they had been administered in a previous shift, even though the med was listed as an allergy. I'll ask the patient if they had any sort of reaction when it was given, and the answer has always been no. I think it's pretty clear that a lot of times, medications are falsely listed as allergies, and at my facility, the nurses seem to just kind of ignore it. When I ask what I should do, I'm always told that since the patient didn't have any sort of reaction then to just go ahead and give it.

I've asked if I can just remove these from the allergy list, and they'll tell me no, don't mess with it. I've called a doctor before about it to see if I could get a med switched to something not listed as an allergy, and she acted kind of annoyed and told me that if the patient had been getting it for days and nothing happened, then it's fine.

I just want to point out, that this has never happened if the patient has a true allergy, meaning that they say they get itchy, swollen, have SOB, etc. when given a medication.

I know that this is a bad practice, but it looks like it's the norm where I work. Is the the way it is at other places? I don't want to make a stink about something that's not actually a big deal.

Another thing that I'm confused about, and that I haven't gotten a straight answer to when I'm at work, is how the FIRST nurse to give the medication knows it won't cause any sort of reaction. I guess they ask the patient, but I feel like the patients can't always be trusted to be accurate. It would make me nervous to give a med that a patient was "allergic" to, even if they told me that it upset their stomach once ten years ago and had it listed as an allergy, but has been fine every other time.

Anyway, how would y'all handle that? Or how do y'all handle that when/if it happens at your facility?

[HouTx, BSN, MSN, EdD]

You need to comply with your organization's policy. If there is no policy (there should be) - ask a pharmacist.

Whenever a person has a 'reaction' to something, they tend to interpret it as a allergy because that is the simplest explanation. We (nurses) know that the two are definitely NOT the same thing, but that doesn't mean that we can just disregard the patient's self-reported medical history. If you are documenting all claims of allergy along with a description of the self-reported "reaction", that should be sufficient. Ask the patient's physician to discuss it & make the differentiation - that's their bailiwick.

[JustBeachyNurse, LPN]

Does your facility use an EMR? Then how is the drug when ordered not being flagged as conflicting with allergies entered? Same as a potential drug interaction or potential cross reaction. (Like penicillin vs. cephalosporins). The pharmacist continues to fill the order for a med with a patient reported allergy ?

I know some facilities have taken to differentiating intolerable adverse effect vs. allergic reaction. (Such as serious changes in labs or idiosyncratic reaction) vs. allergy (rash, local, or anaphylactic.) which to me makes sense.

Have you consulted with the pharmacist or facility P&P for guidance?

On a side note I did get annoyed with the medical assistant that took it upon herself to add a codeine allergy to my physical form (I do have two true drug allergies ) because I won't take it as it causes severe abdominal pain/spasm. The doctor clarified the reaction and crossed out allergy. Fortunately no one NEEDS codeine.

[psu_213, BSN, RN]

On our EMR, we list anything that the pt claims to have as an "allergy." There is then a spot for their reaction (anaphylaxis, hives, nausea, etc.)--even if it does not qualify as a true allergy. Based on that, our pharmacy determines if it is appropriate for them to have the med. If it is an anaphylactic rxn, they they are obviously not going to get the med. If the reaction is something like nausea, we will usually give it, most often with premedication with something like zofran.

For example, we had a patient who had broken her hip. She was going to be examined in the ER by ortho. The only opioid to which she did not have a true allergy was dilaudid. She was too uncomfortable for the ortho exam. We premedicated with zofran, gave the dilaudid and everything went fine.