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.
Our EMR lets your enter things as either "allergies" or "intolerances." I love this. The only people that ever enter an intolerance, though, are the pharmacists. The nurses are entering that codeine makes them constipated, albuterol makes them shaky, and Benadryl makes them tired as allergies. Some of the comments are really funny, the things people attribute to being caused by medications. If a patient has 10+ medications thet feel make them dizzy...
I don't know how many times I have carefully documented the food sensitivity or allergy, such as lactose, nuts, seafood, eggs, tomatoes, and the reaction, and dietary sends that food anyway.
It seems like every single time I put in an allergy to tomatoes they send tomato soup.
In my job I spend a fare amount of time asking questions so that I know if I can administer a med, vaccine, etc right then. It isn't just info-gathering; I really need to know if someone's going to have a true allergic response, and if so....WHAT response.
I ask about medications they might be allergic to, and I hear about how cats make them itch. What other "medications" are off limits? Grass. As in the stuff lawns are made of. Ok.....you'll be good with the flu shot, then
And when I really do GET a response about an actual medication that has caused an allergic reaction, what do I hear? That Benadryl makes them very drowsy.....yeah....not an allergy. That they always have a reddened, sometimes raised area where they were vaccinated....yeah.....not an allergy.
Much depends on the person in front of me as to how I proceed. I'm expected to provide patient education, and for me that includes responding to all the information presented. I WILL let him or her know what to look for in a true allergic reaction, and why what they've considered to be an allergic reaction is really just an anticipated side effect.
FWIW, I never have anyone mad at me for "disillusioning" them or whatever; they tend to be happy for the clarification. Presentation is the key to reception :)
Okay, so what are people's thoughts on amoxicillin rashes?
When my youngest was 2, he received amoxicillin and on day 7 or 8, he broke out into an itchy swollen rash over his entire body. In my reading, that seems to be a not-uncommon reaction and not a true allergy. But his physician at the time said "Let's just be safe and put it as an allergy; there are plenty of other antibiotics out there to use." But I don't want to tell him all his life that he has an allergy to cillins if he doesn't.
This has happened to both my kids as well, both on day 8-9. I sent my son to school with it and wrote a note to the nurse, who fortunately happened to agree with me. I've seen a lot of anecdotal and literature evidence that the amox rash is a fairly common SE without being a true allergy. My daughter got it the very first time she took Amox, but my son had taken it multiple times before having his reaction. I wasn't sure what to make of it.
I'm of a mind to have both kids tested to see if it's a true allergy. If it is then fine, but if not I don't want to take PCN out of our toolbox! It's a great drug.
It's not the patient's lack of understanding that is irritating. It's the fact that a NURSE (or someone with the authority to take a medical history) enters these things into the legal document that is a medical record. Did you read the initial rant?
I had a patient who had NKA listed on her chart. She said NKA when asked. However, when I spiked her antibiotic she said "Oh, I can't take that. It makes me sick". I did some lengthy teaching about allergies, but it made no difference to her. She absolutely refused to allow me to administer the drug, and she insisted I call for something else. I had to waste a very expensive medicine, and we ate the cost.
I listed this as an allergy not because it was, but because I thought it might save the next nurse from having to go through the lengthy complication that I had to.
There should be two areas to enter drug reactions. When there's not, sometimes you have to do what you have to do.
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?
ETA: I was wrong about the iodine, based on KatieMI's excellent posts. Fact remains, though, that consuming those things which contain iodine bound to proteins results in allergic symptoms. I didn't know about the pink coloring in stuff being povidone, though-- thanks, that's interesting.
Not all allergies are fatal, so saying you're not really allergic to something because otherwise you'd be dead is nonsense. :)
No words. Well, actually I do have words. Start hiring real nurses (LPN/RN) instead of MAs for doctor's offices. Yes, the doctors will have to pay them more, but the likelihood of this boneheaded move happening is much less.
Um, have you meandered over to the thread re: magical vitals signs etc.? Wow.......
Delayed allergic reaction can be real and serious, too. I was always told from childhood that I was allergic to penicillin, which they discovered when I had one of many otitis media bouts, so I always took something else.
Fast-forward a few decades: I am an inpatient with a good whopping infection, with an allergy of PCN in my chart. One sunny Friday morning I am approached by an earnest young house staff member who's working on a research project to develop a skin test for PCN allergy they can use if somebody comes in unresponsive and PCN might be indicated for their sepsis, or whatever. Would I be interested in being part of this study? Oh, sure, sez I, always ready to give up my body to science, and I'm not going anywhere anyway. :)
So I got the skin test, and had no reaction, not a thing. Hmmm, says I, they always told me I was allergic, but what the heck, so it would be more convenient if I weren't. So they give me a 5000 unit test dose, and nothing happens. Bonus! I'm not allergic to PCN! So then first thing Saturday morning the nurse comes in with my IV piggyback of whatevercillin, and BOOM. Within 10 minutes my eyes puff up, my lips and ears puff up, I wheeze, I break out in hives all over like you wouldn't believe. I clamp it off and call for the nurse, ask for 100mg of diphenhydramine (Benadryl) and tell her not to give me any more of this stuff.
It appear that I was, in fact, allergic all those years ago, but without a recent challenge, my immune system decided not to stay on alert. Once challenged with that 5000 unit dose, though, it swung into full action, and all read to leap into the fray with the first IV dose on Saturday. A year later, when somebody hit me with Keflex for a hit of mastitis, BOOM again. That's when I learned about cross-allergenicity to cephalosporins. :)
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.
blondy2061h, MSN, RN
1 Article; 4,094 Posts
Our EMR lets your enter things as either "allergies" or "intolerances." I love this. The only people that ever enter an intolerance, though, are the pharmacists. The nurses are entering that codeine makes them constipated, albuterol makes them shaky, and Benadryl makes them tired as allergies. Some of the comments are really funny, the things people attribute to being caused by medications. If a patient has 10+ medications thet feel make them dizzy...