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

[NurseLoveJoy88]

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?

[klone, MSN, RN]

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.

I'm quite calm, thank you.

I know a lot about hospice. I also know that if there is an allergy documented, it needs to be clarified (which is what I said in my first post). It's my license on the line, and I'm not going to *assume* the "allergy" is nausea or itching until I clarify what the allergy is. I'm going to assume worst case scenario (again, because my license is on the line) until I know otherwise.

The idea that "he's dying anyway, what difference does it make?" is what I might have sounded a bit het up about. Because the idea that anyone would think that just kind of floors me.

[klone, MSN, 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.

In hospice lingo, actively dying means probably will die within the next few days or weeks. As opposed to people who are on hospice for months, even years.

[iteachob, MSN, RN]

The allergy should be clarified as to type of reaction. Morphine, because it is a natural opiate, WILL cause histamine release.....hence the itching that is so common (but not a true allergy reaction).

[linearthinker, DNP, RN]

In hospice lingo, actively dying means probably will die within the next few days or weeks. As opposed to people who are on hospice for months, even years.

Ah, the reason for the disconnect. I don't know my hospice lingo apparently. when we say actively dying in critical care, we mean now. As in dead before shift change.

[linearthinker, DNP, RN]

The allergy should be clarified as to type of reaction. Morphine, because it is a natural opiate, WILL cause histamine release.....hence the itching that is so common (but not a true allergy reaction).

ITA and thought this much was self evident. Apparently, wasn't

[Kyrshamarks, BSN, RN]

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.

I think I would delete this post if i were you. you just admitted to violating HIPAA. Since you had no direct contact or care with this patient you should not have been reading the chart on this patient. Nor should have the nurse pass on any info to you about the patient other than in report to you if you are assuming care or in charge.

WRONGFUL DISCLOSURE OF INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION

"SEC. 1177. (a) OFFENSE.--A person who knowingly and in violation of this part--

"(1) uses or causes to be used a unique health identifier;

"(2) obtains individually identifiable health information relating to an individual; or

"(3) discloses individually identifiable health information to another person,

shall be punished as provided in subsection (b).

"(b) PENALTIES.--A person described in subsection (a) shall--

"(1) be fined not more than $50,000, imprisoned not more than 1 year, or both;

"(2) if the offense is committed under false pretenses, be fined not more than $100,000, imprisoned not more than 5 years, or both; and

"(3) if the offense is committed with intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain, or malicious harm, be fined not more than $250,000, imprisoned not more than 10 years, or both.

http://www.hhs.gov/ocr/privacy/hipaa/administrative/statute/index.html

[NurseLoveJoy88, ASN, RN]

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)

Thanks and this is so true ! Once again I DID NOT TAKE CARE OF THIS PT. AT ALL. so when you say " you" that is incorrect. One of my coworkers took care of this pt. on her unit not me ! Just wanted to clarify this... but other then that I agree with you.

[linearthinker, DNP, RN]

Jesus, here we go again w/ the hippo nonsense.

[NurseLoveJoy88, ASN, RN]

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.

I should of clarified in my OP. I used to take care of this pt. but not while the pt. was actively dying. So yes I knew there was an allergy listed but I never cared for this pt. while he was in the dying process thus... I have never administered the drug. After the pt. expired I looked for any documentation r/t the allergy and there was none.

[Fribblet]

Oh lord. It's not a HIPAA violation.

If it were then any time a nurse asks another nurse's opinion or asks a question of a nurse while caring for a patient, she's "violated" HIPAA.

Frankly, when I'm working, I have right to know about every patient in the ER. I don't go looking at charts willy nilly, but I help out my coworkers, often without being asked. If I'm not doing anything and someone else has something to be done, I grab the chart and go.

Are the HIPAA police going to come take me away because I wasn't "assigned" that patient? No.

If a new nurse (or an older one) asks me to look at something in the chart either for clarification or to ask an opinion, should I plug my ears and run away screaming so I don't hear anything about a patient I'm not assigned? No.

OP, you haven't violated HIPAA. Use your best judgement, and don't let the scare mongers frighten you.

[RNKPCE]

How many times have you not been able to read a doctors writing and need another nurse's opinion about what is written in the progress notes. This is not a HIPAA violation.

I wish they would separate out allergies from side effects on patient charts.

[netglow, ASN, RN]

No, "Actively dying" in hospice means, they are actively dying. Not weeks. It means now, on the way out. This might take a few days or a few minutes. Not weeks. Actively dying means initiation of continuous care, which is 24 hour care 1:1 bedside, where I worked, family is summoned for travel in ASAP.