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]

"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

Just want to second everyone on actively dying meaning at most one or two days ect..... we always get a good laugh when a hospital floor sends us an 'actively dying' or 'nearing' pt and the pt arrives ordering dinner and walking to the bathroom..... My favorite was a pt who they said was in septic shock and not responsding to abx.......they thought she was dying and discontinued all of her abx....and sent her our way, she arrived from the hospital Alert and oriented and when i was doing her assessment and asked her about her goals she said "well im a little confused about , I thought they told me i was coming here to die but im feeling pretty good" we thought it was maybe just a 'last hurrah' but started an alternative abx.................I saw her not to long ago and she was living independently at home again. Understanding the s & s of impending death is somewhat of a skill. we get lots of nurses as 'pts family ' at our acute side and its very very emotionally hard on them because they recognize decline really well medically speaking but they jump into the 'actively dying' mindset way to early. I try to provide even extra education to help prevent that emotional burnout...its really hard to watch

[linearthinker, DNP, RN]

You people are going all crazy on me. Who was recommending to ignore allergens that have caused throat swelling. I'm talking about ignoring a rash in someone who is going to be dead in a few hours, and you are talking as if I said just put a pillow over his face and get it over with, lol.

[MunoRN, RN]

Maybe it's just where I work, but in my experience the most common allergy claimed by patients is to opiates, usually citing "it makes me sleepy". Allergies should be listed with the reaction, so it's possible the MD was aware the patient was not truly allergic to morphine since an allergy is an antibody mediated reaction. Some of my other favorite "allergies": "Lasix-makes me pee", "Everything except dilaudid", "insulin-makes my BG drop below 200, which is not my normal", etc.

[linearthinker, DNP, RN]

Lol at insulin makes my blood sugar drop. I have heard lots of silly allergy complaints over the years.

[ak127]

i give meds people are "allergic" to daily- but i ALWAYS make a note such as "listed allergy to morphine clarified with patient- is experienced as nausea, no SOB/hives, discussed risk/benefit with pt, administered with zofran per order. pt tolerated well"

[linearthinker, DNP, RN]

i give meds people are "allergic" to daily- but i ALWAYS make a note such as "listed allergy to morphine clarified with patient- is experienced as nausea, no SOB/hives, discussed risk/benefit with pt, administered with zofran per order. pt tolerated well"

exactly. and if they do have sob/hives etc, just put a pillow over the ir face and move on to the next pt.

[NurseLoveJoy88, ASN, RN]

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.

Whew ! I was worried there for a sec. Thanks !

[NurseLoveJoy88, ASN, RN]

I think the OP meant to say she didn't care for the patient "at all" during this phase and so the any administration of morphine was not her responsibility.

I dunno. The OP will clarify, I'm sure.

I cared for the patient at one point then was put on another unit. Thus , while he was actively dying I was never the patients' nurse. I never took care of the patient was the order was on file. Hope that clarifies.

[resumecpr]

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

That was a little harsh, don't you agree?

[canesdukegirl, BSN, RN]

I cared for the patient at one point then was put on another unit. Thus , while he was actively dying I was never the patients' nurse. I never took care of the patient was the order was on file. Hope that clarifies.

OK, so that is what I thought originally. That being the case, you were NOT in violation of HIPAA. However, if you see flashing blue lights behind your car one day soon...

[canesdukegirl, BSN, RN]

Maybe it's just where I work, but in my experience the most common allergy claimed by patients is to opiates, usually citing "it makes me sleepy". Allergies should be listed with the reaction, so it's possible the MD was aware the patient was not truly allergic to morphine since an allergy is an antibody mediated reaction. Some of my other favorite "allergies": "Lasix-makes me pee", "Everything except dilaudid", "insulin-makes my BG drop below 200, which is not my normal", etc.

Oh, and just for the record, I am allergic to Propofol. It just knocks me out. Can't stand the stuff.

[ogerpus]

I'm allergic to the 9th beer...it always makes me vomit...