morphine sulfate given even though has an "allergy" listed in chart

[NurseLoveJoy88, ASN, RN]

I work in LTC and a resident has an "allergy" listed in chart to morphine sulfate. The resident was on hospice, actively dying so the MD prescribed morphine. My question is would this be considered a med error or bad practice for the nurse to administer this drug? Will this be a redflag to the state? If I was this residents nurse I would have clarified this with the MD and family. Sometimes residents/patient lists allergies that are not real allergies but are expected side effects. Or maybe the MD discussed the risks and benefits of drug with family. My concern is that NO clarification is documented in the chart. So what do you all think?

[Patchouli]

this should be clarified with the physician that ordered it before it is given.

[ChristineN, BSN, RN]

I think it would depend what the pt's reaction is. Lots of pt's list narcotics as an allergy because they suffer from a side effect of itchiness. If that's all it is, I would just make sure the pt has something available for itchiness like Benadryl

[linearthinker, DNP, RN]

If the person is actively dying, what difference does it make?

[klone, MSN, RN]

Being on hospice does not mean it's okay to give drugs that would cause an allergic reaction.

Being in hospice doesn't mean you can actively do things that would kill them.

I would look into clarification on what the "allergy" was, and what, if anything, was discussed with the family.

I would contact the hospice case manager and ask for clarification.

[NurseLoveJoy88, ASN, RN]

Being on hospice does not mean it's okay to give drugs that would cause an allergic reaction.

Being in hospice doesn't mean you can actively do things that would kill them.

I would look into clarification on what the "allergy" was, and what, if anything, was discussed with the family.

I would contact the hospice case manager and ask for clarification.

Well said I agree 100 percent which was why I was so shocked no one looked into this. Once again I DID NOT care for this patient so obviously I'm not at fault. I know the situation d/t another nurse making me aware of it. Out of curiousity ( spelling) I looked through the pts. chart and was shocked.

There should of been clarification. If the pt. did have a true allergy then the thought of him having a reaction going unoticed bothers me.

[NurseLoveJoy88, ASN, RN]

If the person is actively dying, what difference does it make?

I don't know what difference it would make however I think as nurses if we see an allergy listed we need to get more information and clarify with MD.

[klone, MSN, RN]

If the person is actively dying, what difference does it make?

Well, I know that even if I was in hospice and dying, I still wouldn't want to be killed by suffocation from anaphylaxis.

[Fribblet]

Having done triage for a few years now, most allergies that are listed are not true allergies.

They're intolerances or side effects.

People think getting nauseous after receiving morphine is a sign of being allergic, or getting an upset stomach after taking Keflex means they're allergic. If you ask most people about their "allergies" you'll find that most involve nausea/vomiting, and that very few involve hives or anaphylaxis.

Some intolerances are intolerable; however, and it's just easier to list it as an allergy.

You should clarify, but odds are good that the MD discussed the "allergy" with the patient, discovered it was an intolerance or side effect that the patient experienced and failed to cancel the "allergy."

[tamadrummer]

Lets make this even simpler than worrying about the after affect of you administering the medication.

Are you the person administering the med? Yes, than you know that you will be the one responsible for an adverse reaction due to allergy and malpractice, not the physician.

Go to the physician and clarify the order before you even look at the pyxis(sp). Why would you even contemplate administering a medication when the chart and patient claim allergy? There are too many other medications that can be given. If you cannot get clarification, withhold and notify the nurse manager and wait for the physician to call you back. (As long as there is nothing noted on the MAR or somewhere with in the physicians orders already clarifying the allergy question, thus pre-empting the call to the doctor)

[tewdles, RN]

This happens all the time in hospice. The "allergy" needs to be clarified in the chart. The collaboration with the MD, which includes discussion of the "allergy" to morphine must be clearly documented. The collaboration with the pharmacist to order the morphine and clarify the "allergy" must also be documented.

What may have happened in your situation is that the hospice staff may have documented all of this in their records but not yours. Since you and your staff are people most often administering this med, the clarification and documentation of the collaborations should also appear in your record...to eliminate exactly the confusion that you are experiencing. You should feel free to contact that hospice agency and ask them to clarify this in your record so that your staff can feel safe in administering this medication.

Also, it is important to make sure that the family knows that this med has been initiated even though it was identified as a known drug allergy.

I think Klone may need to take a deep breath...breath in through your nose and out through your mouth, slowly...now repeat. Having an itchy nose or nausea following a dose of morphine does not constitute an allergy...and yet that is exactly what many, many people think when they have that medication listed on their list of known allergies.

[linearthinker, DNP, RN]

When the op says actively dying, I assumed, perhaps incorrectly, she meant w/in minutes. if the pts response has been anaphylaxis, seems like a stupid question, lol, so I also assumed that that was not the case.