Okay to yell at the pharmacist for this?

  1. We had a new pt come in to our office, brand new to us and our entire organization. The MA entered pt's history and also verbally reviewed meds, allergies, med/surg/family/social history as per policy. Doc write rx for augmentin. Fast forward 10 days, pt calls c/o full body rash and itching. Apparently, pt forgot to tell us that pt is allergic to PCN, despite having a reaction as an adult. This is my problem: when the pt picked up the rx, pt realized they had forgotten to mention the PCN allergy and pt then told the pharmacist about it. Pharmacist told pt "I'm sure you've outgrown it by now, go ahead and take it, but if you do get a rash then stop and call your doctor." Pt proceeded to take it and developed itching hands and widespread rash by day 9, then full body rash with generalized itching on day 10, at which point pt called our office. After assessing that it was not turning more severe and advising the benadryl and ER if sx changed or worsened (allergy nurse in previous job so I know the drill), I had MD change the antibiotic and added PCN to allergy list.

    Would I be out of line to call the pharmacy and clarify the conversation, along with doing a little medicaiton allergy education? PCN allergies, especially that happen in adulthood, typically aren't outgrown. I know dozens of pts who claimed an allergy to PCN, and when asked about the reaction say that their mom told them they broke out into a rash as a baby when they got the pink medicine, but this was a reaction in the pt's 20's that the pt remembers well. Another thing is, if a pt tells the pharmacist that they're allergic to the rx they're picking up, shouldn't the pharmacy call the prescribing MD and get clarification or a change of rx? That whole situation has me flabbergasted. How do you forget a big medication allergy, why did the pharmacy tell pt it'd be okay, why didn't pharmacy call us, why did pt take it even after experiencing sx to something pt knew they were allergic to?! Ahhhh!
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    About T-Bird78

    Joined: Oct '12; Posts: 811; Likes: 1,208

    11 Comments

  3. by   ThePrincessBride
    First, it is never ok to yell at your colleagues. That behavior is totally unacceptable.

    That being said, yes, the pharmacist should have contacted the precribing doctor to come up with an alternative medication. Their "advice" was out of their scope of practice and that needs to be brought to their attention.
  4. by   T-Bird78
    I know. I really wasn't going to "yell" per se, but I thought they really should be made aware of their major error.
  5. by   CalArmy
    Patients don't always tell the full story. I wouldn't automatically blame the pharmacist. Pharmacies are generally very careful about allergies and interactions. I would really have serious doubts that a PharD told a patient to take it anyways. Just my opinion.
  6. by   cocoa_puff
    As I was reading your post, it sounds like the patient is blaming the pharmacist for his own problem. Why would the patient not "remember" that he had a penicillin allergy when asked if he has any allergies at the office, but then tell the pharmacist when picking up the prescription? The "you probably outgrew the allergy" is what the patient believed, but then once the rash appeared, the patient knew that he had made a mistake, and shifted the blame to the pharmacist to appear to be the victim in this situation.
  7. by   BSNbeDONE
    Quote from cocoa_puff
    As I was reading your post, it sounds like the patient is blaming the pharmacist for his own problem. Why would the patient not "remember" that he had a penicillin allergy when asked if he has any allergies at the office, but then tell the pharmacist when picking up the prescription? The "you probably outgrew the allergy" is what the patient believed, but then once the rash appeared, the patient knew that he had made a mistake, and shifted the blame to the pharmacist to appear to be the victim in this situation.
    I think the patient is very careless with his or her own health. Why on earth would anyone continue to take a drug that has caused physical suffrage through 10 whole days of therapy, then return to the PCP without so much as a phone call regarding symptoms at onset? This behavior just irks me to no end! And I know my feelings stem from two of my own relatives who purposely engaged in this behavior so much so that they became totally dependent on their families for their care.

    It reminds me of a conversation I had with a non-medical friend of mine. He was feeling so sorry for a diabetic classmate of ours. This guy could be seen endulging at every social function there was...completely oblivious to his health issues. My friend wondered why I responded in a sarcastic fashion. I explained that it was because a lot these individuals do exactly what they want to do (that's what keeps me employed), will not follow medical advice, and as such, end up with kidney failure, hypertension, etc., eventually meeting their demise and leaving families wanting to sue healthcare workers when, in essence, the idiot (our classmate) killed himself.

    The patient in the OP's post could develop a systemic infection as a result of this rash and his/her lack of action and then what? Point all fingers at the pharmacist? State that he did indeed inform office staff of his allergy to PCN and proceed to accuse the office of not flagging his file appropriately with the allergy? I mean, what's the purpose of proceeding or continuing to take a medication that you know will cause of has caused you to break out in hives, unless you have an agenda? Once the allegations begin to roll, they don't stop without one heck of a fight, with the healthcare worker being on the defensive end and the nurse, in particular, fighting to maintain employment.

    I apologize, but the behavior in this post just struck a nerve with me based on personal and professional experience with not only patients, but family and friends, too. I think this is extremely selfish, stupid, sick (take your pick) behavior on their parts, and although I've become an expert of concealing my true thoughts from stupid people, I'm so over spinning wheels with these individuals and their health issues. It is a complete waste of time trying to educate these folks and it makes going to work become only about making a dollar. Seeing that I only work no more than two days per week if that, even the dollar has very little motivation for me at this point.

    And yes, I have already put two other professional courses of action into play: one being a change of scenery (tropical) in the same line of work, hoping for a mental refreshening and hoping to regain some of that lost compassion; and the other puts me back in business suits and alone in rental cars again (I so hope they get the lead out with their onboarding process!). So, whichever comes through first (waiting on CRC results---last time I checked, I hadn't killed anyone), it's a wrap!
  8. by   MunoRN
    What you're describing is a delayed sensitivity reaction, not an IgE mediated allergic reaction. Based on the Antibiotic Stewardship programs everywhere that I've worked, this wouldn't justify a switch to another antibiotic since this doesn't signal a potential life threatening reaction, if the rash is poorly tolerated then they might add benadryl or also famotidine, but they would need to stay with that antibiotic. Rashes aren't fun, but antibiotic resistance due to misuse is a very serious problem.
  9. by   amoLucia
    Any chance that it was a pharm TECH that gave some poor info to the pt??? A non-professional with limited education and understanding re allergy responses? And then poor follow-through.

    Yes, the pt was a poor historian, but might the wrong person be being erroneously judged? In my dealing with pharmacists, personally and professionally, I've always found that they were very knowledgeable and cautious professionals. (Sometimes to the point of being a PIA.)

    Place blame where blame is warranted. Contact with the Pharmacy should be made but with the purpose of it being an informative and corrective action.
  10. by   Ruby Vee
    "Yell" at someone? Absolutely not!
  11. by   KelRN215
    Quote from cocoa_puff
    As I was reading your post, it sounds like the patient is blaming the pharmacist for his own problem. Why would the patient not "remember" that he had a penicillin allergy when asked if he has any allergies at the office, but then tell the pharmacist when picking up the prescription? The "you probably outgrew the allergy" is what the patient believed, but then once the rash appeared, the patient knew that he had made a mistake, and shifted the blame to the pharmacist to appear to be the victim in this situation.
    Pharmacists are my closest colleagues at my current job and I don't believe for a second that a Pharmacist really told the patient "oh I'm sure you outgrew that allergy" and wouldn't call the MD to clarify the prescription/allergies. Patients aren't always accurate historians. I think it's fine to call the Pharmacy and say "Mr Smith was prescribed Augmentin from our office. He didn't report any allergies. He came back with a rash on day 10 of his course and states that when he picked up the prescription, he mentioned an allergy to Penicillin and was told that he had probably outgrown it and it was fine to take the med as prescribed" and get the Pharmacist's account of what happened. But to YELL at the Pharmacist? Just based on the report from a patient who "forgot" about is allergies then didn't call about a rash for 10 days? No.
  12. by   NanaPoo
    Call the pharmacist to do a little medication allergy education? For reals?
  13. by   AZPharmD
    http://www.annallergy.org/article/S1...339-3/fulltext

    few RPHs make it through school without becoming anal PIAs about stuff like allergies. if the patient said they had a penicillin allergy but iddn't mention it started in adulthood, it's possible an RPH might treat it like a childhood allergy which is likely to be outgrown. report it back to the pharmacist and they'll note the patient file. no need to yell.

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