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 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?
As I stated in my earlier post, my physician's EMR has a space for "Allergies" that does not have categories for sensitivities/intolerances/adverse reactions. In my case, my physician enters information that falls into these other categories under the section for "Allergies" with a description of the reaction and any other information considered necessary; this differentiates the reaction from a true allergy. If there is no space for this information to be recorded but under "Allergies", where do you think this information should be listed? If I am in an emergency situation where epinephrine is indicated, I would like my physicians to be aware that I am sensitive to cardiovascular side effects of the drug, and to factor that into their treatment; i.e., consider a reduced dosage and carefully weigh up risks/benefits of giving. My own physician believes my sensitivity to epinephrine is of medical significance, not just "patient preference/patient doesn't like the feeling of", and noted this information in detail under "Allergies." I don't see how this could be unethical. I don't think anyone is talking about following the patient's beliefs without question.
Specializes in Med nurse in med-surg., float, HH, and PDN.
Well, I'm not allergic to Zofran, but it does absolutely nothing for N/V with me. I put it under my list of allergies simply so (hopefully) someone will not take an order for that and give it to me. Phenergan, only, please.
All we can put is "allergy" to XYZ and reaction, I inform my patients that if the reward outweighs the risk the dr may order it (for the drugs that have side effects). I had someone in pain freak out on me because they were in pain and wanted the ordered Lortab but I needed to call the dr. first because they insisted they were allergic APAP.
I had a patient tell me that she was allergic to tylenol because it gave her a headache. Really?
I'm not allergic to Vicodin, but it gives me a headache, too. I would rather not take it if I don't have to (though when I have bronchitis and are completely exhausted from coughing, that works pretty well on its own - then I'll deal with the headache).
I took care of a retired ER nurse last night. She was telling me about how she used to wear the white dress and the cap, and how her cap would always get tangled in the privacy curtain! We compared notes on charting by hand written narrative vs. computer based click boxes. I miss hand written narratives. You think differently when you have to write a narrative note vs clicking a bunch of boxes on a computer screen. Although, I have to admit that I do love the efficiency of the click boxes.
I took care of a retired ER nurse last night. She was telling me about how she used to wear the white dress and the cap, and how her cap would always get tangled in the privacy curtain! We compared notes on charting by hand written narrative vs. computer based click boxes. I miss hand written narratives. You think differently when you have to write a narrative note vs clicking a bunch of boxes on a computer screen. Although, I have to admit that I do love the efficiency of the click boxes.
I liked my cap, but only wore it one yr. When I started in CCU no hats since they were considered unsanitary. It was fun backthen to see the different caps, styles, ribbons.
I liked narratives too, I just charted by the systems. Oh well, its gone with the wind.
Most Drs don't even read the checkboxed notes. One younger Dr was surprised we did a physical assessment each shift!! I started saying charting was for lawyers. Such a cynical person I can be.
I'm not allergic to Vicodin, but it gives me a headache, too. I would rather not take it if I don't have to (though when I have bronchitis and are completely exhausted from coughing, that works pretty well on its own - then I'll deal with the headache).
I wore a cap at my pinning ceremony, but I can't imagine wearing one while giving patient care! I do too much bending and stooping and moving around in general. I think it would drive me insane.
Our assessments aren't readily visible to the physicians I work with. The best bet for getting information to them, besides face to face, is a narrative note. The systems assessments are buried too deep for the physicians to go digging after.
Specializes in Med nurse in med-surg., float, HH, and PDN.
It is very difficult to 'paint a picture' of a patient's true condition by clicking on boxes; invariably the computer-clicking mode of charting is missing something, and ignored by all except those forced to complete it, and Quality Control, whose job is to see that everything in the chart is all matchy-matchy, looking for continuity and precision. People who are ill, either with or without co-morbidities, are frequently discontinuous and imprecise.
Well, since I don't work in a Hospital anymore and don't have to chart-by-clicking, I may be totally full of hot air and wrong. I am Raging Against The Machine simply because I have more of an attachment to descriptive words than to a list of X's or checkmarks.
I am a bumptiously unrepentant COB with an allergy to serious nonsense.
I like my checkbox + narrative system. We can add comments on every section as we go. I can use the checkboxes alone to chart a normal assessment in about 5 minutes on a patient about to be discharged. I can add detailed comments to paint a clear picture of a critically ill patient's condition- plus use the checkboxes so he gets a high acuity score.
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.
-(me): are you allergic to any medication?
- (patient): to adenosine
- (me): - what happens?
- (pt): it makes my heart stopping and I may die.
Ok, fine. Admission paperwork goes by. When asking about code status, we are required to actually name short list of potential interventions. All goes as usual, I explain things if needed. Till...
- (pt): - what is external pacing?
- (me): (explain)
-(pt): - does it hurt?
- (me): - yes, it can be very painful.
- (pt): - yes, I had it before...hurts like h***. Will they put me to sleep for that?
- (me): - probably not (explaining why)
- (pt): - do you have something else for that? It just hurt SO MUCH!
- (me): - yes, there is a drug, it is named adenosine (explaining 101)
-(pt, thoughtfully): - well, then I may not be allergic to that stuff after all...
.thumb.gif.9c97ffa9443a5f22ff38e1eac832292c.gif){kind=avatar}
Susie2310
2,121 Posts
As I stated in my earlier post, my physician's EMR has a space for "Allergies" that does not have categories for sensitivities/intolerances/adverse reactions. In my case, my physician enters information that falls into these other categories under the section for "Allergies" with a description of the reaction and any other information considered necessary; this differentiates the reaction from a true allergy. If there is no space for this information to be recorded but under "Allergies", where do you think this information should be listed? If I am in an emergency situation where epinephrine is indicated, I would like my physicians to be aware that I am sensitive to cardiovascular side effects of the drug, and to factor that into their treatment; i.e., consider a reduced dosage and carefully weigh up risks/benefits of giving. My own physician believes my sensitivity to epinephrine is of medical significance, not just "patient preference/patient doesn't like the feeling of", and noted this information in detail under "Allergies." I don't see how this could be unethical. I don't think anyone is talking about following the patient's beliefs without question.