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.
I'm a psych nurse and lots of my patients are allergic to Haldol, Prolixin, Seroquel, Thorazine, Stelazine, Loxitane, Fanapt, Abilify, Geodon...but they can take Norco, Klonopin, Ativan....
My DOCTOR listed Lisinopril as as allergy for me because it made me cough! Coughing is a common side effect of Lisinopril and if it was the only blood pressure med that helped me, I would take it. I do develop itching on my hands if I touch crushed phenobarb.
I'm a psych nurse and lots of my patients are allergic to Haldol, Prolixin, Seroquel, Thorazine, Stelazine, Loxitane, Fanapt, Abilify, Geodon...but they can take Norco, Klonopin, Ativan....
My DOCTOR listed Lisinopril as as allergy for me because it made me cough! Coughing is a common side effect of Lisinopril and if it was the only blood pressure med that helped me, I would take it. I do develop itching on my hands if I touch crushed phenobarb.
Coughing with an ace inhibitor is actually considered a serious reaction due to altered bradykinens, which can cause bronchospasm and closure of the airway. There are treatments out there to counteract the reaction to ACE inhibitors but most of them carry potentially serious side effects of their own and their use for this purpose is not well studied, so generally the safest option is just to take a patient off of ACE inhibitors who develops cough clearly related to the med.
I completely agree that we should be assessing for and properly documenting medications that the patient does not want to take and under what circumstances they do not want the med, but I don't really see just putting that in as an "allergy" as being ethical.
To use epinephrine as an example since it's actually a common one, it's not unusual for a patient to dislike how epi in a anesthetic at the dentist makes them feel. Epinephrine, aka adrenaline, is a normally occurring substance in the body and you can't really be allergic to it, the increased heart rate, contractility, and blood pressure is actually an expected effect when epi is used as anesthetic since it will be absorbed into the blood stream, what people usually notice is when the dentist injects where it's absorbed into the blood stream more rapidly such as directly into a vessel which admittedly isn't a very comfortable feeling.
To assume that because they don't like the feeling of epi while they're trying to relax at the dentist office, that they then wouldn't want epi to treat an allergic reaction or being mostly dead would be highly unethical since that isn't an informed refusal of epi for that purpose. This is why it's actually pretty important to define these distinctions with the patient, even though it often involves politely challenging their beliefs. Unless you've thoroughly explained the effects of listing something falsely as an allergy such as all the other meds they won't be able to get due to cross-reactivity, I don't see how it's ethical just document something you know to be false and that the patient doesn't really understand what they are deciding.
Lets say someone is convinced they need open heart surgery for bypass grafting because their tarot card reader said they did. If the available evidence about the patient's CAD said they don't actually need bypass surgery, would it be ethical for a surgeon do just do the surgery since after all we should just follow the patient's beliefs without question?
You are not allergic to your erectile dysfunction medication. A runny nose is a side effect because the medication causes vasodilation. (I'd forgotton about that one).
Sometimes Items get entered as allergies because the families or patients insist on it and won't take that medicine, despite the fact that they aren't really allergic. No amount of education ever changes their mind, and it saves us a lot of grief when the doctor orders that med to be able to say it's not an option. It would be better if there was a category as to 'Patient's preferences' though but I don't see that happening anytime soon.
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.
interesting. Maybe not all insulin though? Just aspartame? Thought you might appreciate this article:
I completely agree that we should be assessing for and properly documenting medications that the patient does not want to take and under what circumstances they do not want the med, but I don't really see just putting that in as an "allergy" as being ethical.
Not all EHRs have the option to distinguish what is an actual allergy vs an intolerance vs an adverse reaction, etc. In fact, a lot of places still document on paper, and hand writing all of that in there is so cumbersome as to be extremely impractical- not only from a perspective of how time consuming it is, but even more basic as that there is not enough space for it all.
The OP was talking about how they are transitioning from one EHR to another, which makes me wonder if the old EHR did not have the capability of distinguishing between allergies vs intolerances.
I could be wrong about that, but even if I am, I'm still a little put off by folks griping about what other people are or aren't doing. Maybe it's just me, but I feel like if you have the time to worry about what others are doing, maybe you have too much time on your hands, or you should become a manager.
Aspartame raises my blood sugar & BP. As does most other artificial sweeteners.
An interesting note on that is a friend has to avoid Nutrasweet because he's also allergic to kidney beans.
I had to deal with an irate teacher once because I wouldn't eat cookies she had made with banana & strawberry filling. Allergy to banana stopped me & my best friend was allergic to strawberries. We were told they weren't that good anyway. But I still had a note from the teacher for my mom to sign for defying her request.
vfilomeo
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I'm a psych nurse and lots of my patients are allergic to Haldol, Prolixin, Seroquel, Thorazine, Stelazine, Loxitane, Fanapt, Abilify, Geodon...but they can take Norco, Klonopin, Ativan....
My DOCTOR listed Lisinopril as as allergy for me because it made me cough! Coughing is a common side effect of Lisinopril and if it was the only blood pressure med that helped me, I would take it. I do develop itching on my hands if I touch crushed phenobarb.