So we are switching to a new computer system at work. Not everything will carry over and we have to do some manual entry of certain things. Allergies is one of the items that falls onto that list. We are able to print out that info from the old system so we can put in onto the new, so the information has all been verified at some point by nursing staff or physicians. Which also means at one point it was all ENTERED by someone with a license or someone who is supposed to have enough medical knowledge to do such things.
Some of the "allergies" (complete with reaction, since it's a required field):
Nitroglycerin---"it makes my ears ring"
Tetnaus shot---"my arm hurts after I get one"
E-mycin---"diarrhea"
iron supplements---"makes my BM dark"
and my favorite:
Epinephrine---"makes my heart race"
Seriously?! I can shrug and say "meh" to many things, but truly?! WHY do trained professionals DO this? Go ahead and put some of these things down and attribute the poops after an ABX to a side effect, but not an ALLERGY. Yes, side effects, intolerances and allergies are all options to choose from.
I am not even entering the epinephrine "allergies", nope, not doing it.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
The OP is just venting and probably spending hours correcting electronic data.
Plus, this thread is sort of funny.
I thought this was going to be a gloriously funny vent thread -- but it got real snarky real fast!
I love all the folks who are allergic to "tylenol, aspirin, ibuprofen, naprosyn and toradol. The only pain medication I can take is "that oxy one." Oh, and dulauda."
Angioedema and laryngeal edema from ace inhibitors, such as enalapril, is listed as a side effect or an adverse effect in the drug references.
It is a histamine response so I list it as an allergy.
Sometimes I wonder if the manufacturers tend to downplay this life threatening reaction.
I've had a few patients with angio edema so bad that they end up intubated until we can get the swelling down to normal size. Most were from "pril" meds and others from food. I tell the patient and next of kin to ALWAYS tell the doctor, nurse, and pharmacy it's an allergy! I figure if you almost die, yep it shouldn't be given ever again...ergo, list it as an allergy!
As for the rest, yeah we get lots of stuff listed as allergies, but I always ask what happened when they took it and list that too. The allergy is labeled mild, moderate, severe and the doctors and Pharmacists review it before approving a medicine.
A couple of years ago I was in and out of the hospital for several months. I was steroids and they were doing accuchecks on me. They gave me aspart insulin for a high blood sugar, and I had a major reaction to it. Within about 3 minutes post injection my heartrate went into the 140's and my bp hit about 210/130, O2 sats droppped into the 80's. Thank god I was on tele. They rushed into my room and rapid responsed me. My doc comes in later and tells me in no uncertain terms to always list insulin as an allergy from now on. I am one of the rare people out there now that are allergic to insulin.
I ended up back in the ER shortly after that with complications and they called in some other doc other than mine. He asks about allergies and I say insulin. He looks at me and says that is impossible. You cannot be allergic to insulin. I immediately kicked him out of the room. People can be allergic to insulin I found out after researching it. He was an idiot if he did not know that.
So now when someone says they are allergic to something, I take it as the truth.
But you really CAN'T be allergic to insulin itself. It's a naturally made hormone that's in your body RIGHT NOW or you'd be dead. You can absolutely be allergic to components of the man made insulin, or even the needle or syringe they used to inject it. But not insulin. And the symptoms you had, while certainly extremely serious, don't sound histamine mediated (particularly the hypertension). Thankfully, in your situation, the hyperglycemia was self limiting. But if you were to need your pancreas removed or develop type 1 diabetes you'd have no choice but to find some formulation that works for you.
I'm curious how they treated this reaction, and what you were in the hospital with requiring steroids to begin with? Was it ruled out that this wasn't some kind of incidental event, such as a PE, that just had coincidental timing?
So a patient states an allergy, real or imagined....so what? How does it hurt you? So you decide that it's not a real allergy and don't put it on the medical record and then the patient actually does have some kind of reaction because of your perceived superiority. Guess whose fault that is? The first time I took Celebrex I got a rash all over my body. It took nearly a week to materialize. The second time I took it, just to make sure it was the Celebrex, I had an anaphylactic reaction. If someone had written off the rash as unimportant, I could have died! It's not your call to decide who is allergic and who isn't. Sometimes the patient just doesn't want to take that drug...that's their call. You don't get to decide what the patient takes, especially if it's against their will.
This actually happened to me and I'm still so mad about it. Everytime I went to the dentist I was having some kind of major reaction to the anesthesia but I didn't know which one, as they were using different ones each time. I assumed it had to be a rebound from the Epi so I declined anesthesia with Epi in it for a while, and would get the same rolled eyes from the staff because they didn't know I was an ICU nurse and knew exactly what Epi was. After several tries I discovered that it was actually many of the "....caines" that were causing the reaction and that if I stick to Lidocaine and Epi only, I do not get the reaction at all (extreme drowsiness, somnolence, unable to drive etc). One dentist thought as many of you did, that it was all BS, and gave me one of the other drugs because he felt like he knew better, and totally ruined my day. I was unable to drive home and had to cancel my plans for the rest of the day. I was so mad! This is my issue, I am the patient, and I decide what I will take and what I will not take. Nurses are required to be the patient's advocate. It's not the nurse's place to mock and ridicule a patient for their experience and preference. Next time that happens to me, I will absolutely take it further and get a lawyer involved. Respect your patient and note what they ask! You are still free to educate them but if they disclose information to you, I would make sure you include it in their EMR or you're letting them down.
Saying you get a rash will likely be taken seriously as an allergy by any health care provider. Those aren't the types of reactions people are writing off. And a patient having a preference when there's a suitable alternative? I'll always advocate for that.
The issue is when a patient has 12 different antibiotics listed as allergies with no clarity, and they all cause a belly ache or diarrhea or a yeast infection or the patient felt they hand the hiccups more frequently on it. Then the patient comes in unconscious and septic and there's no antibiotic that the provider/pharmacist feels can be safely used. Or your have to spend an hour digging through the chart to determine which ones might be okay. Or worse yet- the patient has 12 antibiotic allergies and 11 are bogus and 1 is anaphylaxis and the provider reads the reactions for the first 6 and realizes that "none of these are real" and preacribes the one that causes anaphylaxis. The patient that cried wolf scenario. That's the harm in listing bogus allergies.
sandiamts
33 Posts
I agree Anna. Pharmacy can't enter med with an allergy/bad side effect.