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 Infusion Nursing, Home Health Infusion.
As a nurse you are stuck between rock and a hard place. After questioning the patient about the reaction that occurs when said agent is used and they insist it is an allergy you must list it! You can additionally list what they state is the reaction.If you do not list it and they receive it and have an allergic reaction you would be up **** Creek without a paddle should they sue!
I saw an epi "allergy" recently as well. The reaction also stated that it caused her heart to race. (eye roll)
Also, I'm sensitive to iodine but I don't say that I have an allergy to iodine because, naturally, I would be dead then. I have a reaction to seafood, shellfish, topical iodine, and contrast dye. I've recently been told that it is something in all these things that I am truly allergic to. Any thoughts?
It used to be thought that the reason someone could be allergic to shellfish, but not other types of meats was that shellfish had higher levels of iodine, which is where the shellfish/iodone allergy myth came from. This connection was initially disproven in the 1950's when it was discovered antigens differed in different types of meats, although it still persists today.
You are correct that if it was actually possible to be allergic to iodine then you'd be dead because it's unavoidable. It's added to a number of common foods, notably salt, and if you were able to actually avoid iodine you'd have a goiter on your neck.
It's also not really possible to have an allergy to topical iodine, povidone can cause irritation or allergic reactions when used topically but contains no iodine itself, it just get confused as an iodine allergy when used as a substrate for iodine.
Contrast dye allergies are also not due to iodine and is due to various causes, frequently the osmolarity of the solution and often the preservatives as well.
Wait a second it starts with d, da, do, dill, dilaudid. That's it!
But if you give it to me IV, I can take it that way.....just none of that stuff by mouth. My stomach hurts...and it doesn't work as well, so I am allergic to it that way.
I've also experienced a lot of push back in trying to get nurses to chart allergies, intolerances, and preferences separately, which is unfortunate because the difference between a true allergy and intolerances/preferences are extremely important. When a patient is rapidly declining due to flash pulmonary edema, is it really appropriate to hold the lasix because the EMR alerts you to it being an "allergy" for the patient if it turns out the reaction is that it "makes me pee a lot"? It's potentially a really big deal.
What I've found is that what works best is to just have nurses chart the reaction and then the person being alerted to an allergy can evaluate for themselves what it is.
I personally put oxycontin as an allergy because I hated the way it made me feel. Doctors ignored me when I told them. Puking my up guts isn't going to help any me.
I no longer list it as an allergy, but I understand it if makes some one miserable. It is lack of listening by doctors most of the time.
For life of me I am amazed how many people can be addicted to the drug.
I also find amusing the patients who list allergies/intolerances to several major psych meds (usually some combo of haldol/geodon/seroquel/lithium) but deny a psych history when I ask. Had one that had intolerances to haldol, geodon, ativan, and benadryl. I cringed inwardly -- bet there was a story behind that one.
As an ER I triaged a 7 month old that the mom stated the pt was allergic to steak. I asked why and how he had the steak. She told me she chewed up the meat and gave him him bites out of her mouth. It was the first Time I ever wanted to smack a parent upside the head.
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.
Specializes in Pharmaceutical Research, Operating Room.
I have this corollary that states that the greater the number of stated allergies, the greater the probability that the patient has a mental health history.
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.
iluvivt, BSN, RN
2,774 Posts
As a nurse you are stuck between rock and a hard place. After questioning the patient about the reaction that occurs when said agent is used and they insist it is an allergy you must list it! You can additionally list what they state is the reaction.If you do not list it and they receive it and have an allergic reaction you would be up **** Creek without a paddle should they sue!