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?

[evolvingrn, BSN, RN]

i would clarify with the ordering md before administering but true morphine allergies are extremely rare. morphine side effects....are common and pts are often not able to differentiate between the two.

[CanuckLPN73]

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

Wow...just curious, as one who works in a long term care setting, if we were not allowed to look at residents charts we would not be able to care for them effectively. We work with all the residents, therefore at times when Im not busy I'll find myself sitting down reading through charts out of curiousity. Not sure how this applys in the active setting, however what I'm understanding is that we need to work as a team even on active and many times look through patient charts, espeasally when lab work comes back. A RN may be the charge nurse but other nurses are also caring for that patient so need to look at the chart as well. Not just one nurse does the charting on a single patient, isnt this why we have collaborative team work in the health care field? The Charge Nurse, another Nurse, LPN, maybe another LPN, a health care aid, councellor, dietician, MD, etc are all involved and are all looking at that Clients chart!! From what I understand, that chart is protected from outsiders, we dont take it home or talk about it to friends or family or to other nurses outside of work or on a different floor, or we do not give it to the Police without a court order, etc.

[klone, MSN, 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.

Well, that's not what it means wherever my husband has always worked. He does home hospice, so nobody gets 1:1 continuous care. Instead, he gets a call at 4am that Grandma died, and could he please come and fill out the death certificate.

Actively dying does not mean "gonna kick it in the next hour so it's okay to give a drug that will cause him to suffocate"

[darren_callcareer18]

I know when a client is in the hospice alleviating the S/sx esp. pain and giving the client as much as comfort as he could are our main objectives. Now, giving the client a drug with known allergy will bring the client discomfort. BTW, even the client is in hospice administering a drug to a client that cause him severe anaphylaxis rxn, all legal aspects will be use to the nurse if the relatives WANT it.

[AnnieOaklyRN, BSN, RN, EMT-P]

Most morphine allergies are actually not true allergies. Morphine causes a direct histamine release that can cause erythemia, which some patients may interpret as an allergy to the drug even though it is a known side effect.

[OCNRN63, 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.

I knew you must have been missing something here; I was kind of surprised at your answer!

[linearthinker, DNP, RN]

My mindset was who gives a sheet if a ACTIVELY dying person has a mildly erythematous drug reaction. Little did I know that clarification was not a given (duh) and that there is some debate about who dies how fast and what you label it.

[leslie :-D]

My mindset was who gives a sheet if a ACTIVELY dying person has a mildly erythematous drug reaction.

"mildly erythematous" drug reaction?

how about laryngeal spasms and edema that will suffocate the pt to death...and not nearly fast enough.

hospice or no hospice...

dying should be comfortable to extent possible.

fwiw, i've never seen "active" dying last longer than a day or two, max.

now, when i say 1-2 days, these pts are unconscious that long, before they take their last breath...but is still a part of the "actively dying" process.

leslie

[leslie :-D]

Most morphine allergies are actually not true allergies. Morphine causes a direct histamine release that can cause erythemia, which some patients may interpret as an allergy to the drug even though it is a known side effect.

dermatitis can also occur, but that is the least of our concerns.

we see the true anaphylactic s/s, angioedema, shocky, faint, etc.

leslie

[canesdukegirl, BSN, RN]

Most morphine allergies are actually not true allergies. Morphine causes a direct histamine release that can cause erythemia, which some patients may interpret as an allergy to the drug even though it is a known side effect.

You are spot on in this assessment. Propofol has the same type of effect including histamine release and the resulting skin reaction. I used to get worried about seeing truncal erythema on my pt during Prop induction, but the spots quickly abated and after some research, I found that Prop does have a histamine release mechanism.

MSO4 can be mistaken as an allergy if observed directly after administration with the resulting skin reaction.

Bottom line: if the pt listed MSO4 as an allergy, then clarification must have been communicated prior to its administration.

[OCNRN63, RN]

I was getting a patient ready for surgery, and was going over her meds and allergies. She told me she was allergic to epinephrine. I asked her what happened when she had it, and she said, "It makes my heart race." I said, "OK."

I went over to the anesthesiologist and said, "Don't give Mrs. Jones epi." He said, "Why?" I said, "It makes her heart race." He said, "Man. I hate when that happens."

[tamadrummer]

I was getting a patient ready for surgery, and was going over her meds and allergies. She told me she was allergic to epinephrine. I asked her what happened when she had it, and she said, "It makes my heart race." I said, "OK."

I went over to the anesthesiologist and said, "Don't give Mrs. Jones epi." He said, "Why?" I said, "It makes her heart race." He said, "Man. I hate when that happens."

And you kept a straight face as she said to you, "it makes my heart race."