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.
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.
If you are sensitive to cardiovascular/central nervous system side effects of epinephrine (if you look up the list you will see how extensive it is) you will understand that experiencing these side effects, some of which can also indicate toxicity, is nothing to take lightly. You would want your reaction to be listed under "allergies" if there is no where else to list sensitivities because you would want your medical providers to be aware of these side effects, and to be very cautious in using epinephrine.
Epinephrine is used as a rescue drug, not some routine medication where you're going to worry about side effects. A "racing" heart could very well be why the drug is being given in the first place.
I think a lot of the goofier "allergies" come from it either being impossible or difficult to distinguish between "allergies" and "adverse reactions" in many EMR systems, and from a healthy dose of CYA. If the patients says "I'm allergic to X, it makes me [side effect]," I'll put that in as an adverse reaction or confirm it if it's already in. The provider wanting to give it can see what effect it has on the patient and talk to them about it and make the call whether it's worth dealing with an unhappy patient. But ignore them or even take it out? Heck no. Patient tells me "I'm allergic to X" and I don't put it in or even take it out of the existing record because that's not a "real allergy" and patient gets a dose of X and has the reaction they already reported and is angry, who do you think that's going to come back on? The nurse that took it on themselves to take it out to "clean up" the allergy section because it wasn't a true allergy. I've seen enough meds ordered despite *being* clearly labelled actual allergies, and only being flagged later by pharmacy or nursing, that I'm not relying on docs and patients to clearly communicate with each other about adverse reactions alone to prevent them.
Some systems don't even make it possible to distinguish between allergies and adverse reactions, and then what are you supposed to do? There are all kinds of reactions that aren't true allergies that it's still useful for the provider to know about. Loratidine made me super tachy for hours- that's not an allergy but it was miserable and scary and I sure don't plan to ever take it again. And if I weren't a nurse I might not understand the difference between "allergy" and "idiosyncratic adverse reaction" and tell people I was "allergic" to it. As is, I'd rather they put it in the "allergy" section than nowhere, if that's all that's available in their charting system, and I don't care if it makes some other nurse down the line roll their eyes.
Epinephrine is used as a rescue drug, not some routine medication where you're going to worry about side effects. A "racing" heart could very well be why the drug is being given in the first place.
My comments related to other uses of epinephrine besides ACLS/other cardiac reasons/anaphylaxis, such as when used at the dentist. My physician considered it very important to know about my sensitivity to epinephrine, as experienced at the dentist, and entered this information under "allergies" accordingly.
Specializes in Complex pedi to LTC/SA & now a manager.
I had a patient who was 'allergic' to Tyenol .. until I told her that would mean I couldn't give her her Norco.
I recall one that wanted Vicoprofen but was "allergic" to asprin, Tylenol, Motrin, Aleve, and Advil (pretty much any OTC). When explained, in this case the patient had a debilitating condition and was tired of playing catch up in pain control when pushed to start with non medicinal and OTC. This person was rather reasonable The provider clarified the allergy list (was actually contraindicated for Toradol because of black box side effects ) and was able to start a realistic pain management plan
(I can't have Toradol due to a GI condition but can have the much milder (on the GI tract) ibuprofen or diclofenac.
Except, looking at third party opinions of this test- it's not a well validated test because AGA-IgG testing isn't specific for gluten sensitivity - another nail in NCGS's coffin. Turns out lots of people who say gluten bothers them, have no elevated anti-gluten AGA-IgG levels, and lots of people who have no symptoms with gluten do.
Except, looking at third party opinions of this test- it's not a well validated test because AGA-IgG testing isn't specific for gluten sensitivity - another nail in NCGS's coffin. Turns out lots of people who say gluten bothers them, have no elevated anti-gluten AGA-IgG levels, and lots of people who have no symptoms with gluten do.
Specializes in Med-Surg, OB, ICU, Public Health Nursing.
Well they make a "dye free" benadryl due to allergy to the dye (red food color #?5). I have also had patients allergic to the gelatin that GelCaps are made from, so they ask me to be sure to prescribe Tabs not capules if available. I do work with an allergy/asthma/immunology doc so am learning tons.
It was IV Benadryl, ? food dye? Thanks for any info you can provide.
Maybe the initial intake nurse could just take care of it instead. You know, just do it right to begin with? I know it's an unheard of concept with some people
Not always so easy when the patient is admitted at 3am after being in the ER for 12 hours and has pain rated at a 8, nausea & potential vomiting, or is so tired they can't hold their eyes open. I did one admission on a patient that we were in the process of transferring to an ICU bed because we just discovered a brain bleed after arriving on the floor with a exessively high BP.... Not all admissions are done during daylight hours or sitting quietly at a desk.
Susie2310
2,121 Posts
I agree.