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 Med-Surg, OB, ICU, Public Health Nursing.
As someone who had a code called for me after X-Ray dye, I don't care if you write iodine. Just write something. What used to frustrate me were narcotic seeking patients who were allergic to all NSAIDS, codeine, etc. and could only take MS or dilaudid.
Specializes in Med nurse in med-surg., float, HH, and PDN.
I remember years ago when I was working in Day Surgery, we got this woman who had so many stated allergies it took three allergy bands.
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.
Um, yeah, it's iodine. All of those contain significant amounts of iodine. Iodine allergy is real. ETA: referring to KatieMI's excellent post, I ought to have expanded on this to explain the complexes. 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. :)
It's not real. It is not possible to be allergic to iodine and there is no evidence that an allergic reaction to iodine has ever occurred. There is no evidence of cross-reactivity between iodine and seafood allergies.
A pretty succinct summation from a medical guide: "ARE THOSE ALLERGIC TO SEAFOOD, ALLERGIC TO THE IODINE WITHIN SEAFOOD?No one is allergic to iodine. "
As someone who had a code called for me after X-Ray dye, I don't care if you write iodine. Just write something. What used to frustrate me were narcotic seeking patients who were allergic to all NSAIDS, codeine, etc. and could only take MS or dilaudid.
What you want them to write is "contrast dye", not iodine, since writing "iodine" won't help you avoid contrast dye in the future.
Specializes in OR, Nursing Professional Development.
I had a patient this week who had a single allergy listed in her EMR. When I confirmed allergies with her, she told me that it wasn't a true allergy, just an adverse affect and that she didn't have any real drug allergies. She then told me that if she listed all of the meds she had adverse effects from, it would be about 6 pages of drugs. Since they aren't allergies, she didn't want them listed in the chart as an allergy. Why can't more patients be like that?
I am not listing a naturally occuring substance that your body manufactures as an allergy. Go ahead, sue me.
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.
Specializes in School Nursing, Ambulatory Care, etc..
Many years ago, when I worked in ICU, I had a patient insist I put Narcan on her allergy list. She said it made her "feel awful". I told her I'd talk to the doc about it. When he asked why she thought she was allergic to it, I told him, "it woke her up".
I agree. BUT, in both of our systems, which was the start of my rant, intolerances and side effects are options to choose.
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 recently had a patient admitted for observation after syncope. He also had chronic pain, for which he took non narcotic pain relievers at home. Well he ended up c/o 8/10 pain exacerbation and wanted something different. No problem. I had done his admission and verified his no known drug allergies. He was specific "I am allergic to nothing, no medications or anything". Great! Called the doctor and got an order for small dose of morphine. Went to tell the patient who said, "oh I am allergic to that. Can you give me dilaudid?". I was flabbergasted. So I reminded him that he had told me NO allergies and asked what happened when he had morphine in the past. His reply, "I don't remember".
So you are (now) telling me that you have had only ONE true allergic reaction to a medication in your entire life, but don't remember what happened when you took it? Wouldn't that be somewhat memorable? Nice to mention this now.
Long story short the patient totally backtracked his story when the doctor ordered toradol instead.
Growing up I was told I was allergic to shrimp. The first time I ate it, I turned green over night. Lost everything to the potty. Over the years I questioned wither it was the shrimp, since I had also been told that it might have been mental. So I gave it a test. Nope, still lost everything to the potty.
Several years ago I was discussing this issue with a Chief and it was explained to me that I am describing a sensitivity to the food. Not a true allergy. I have sense learned that alot of people have food 'allergy's' where their actions are more 'sensitive', then what qualifies as an allergy. But what surprised me is that in all these years, not one medical person explained the difference to me. What I was told was, that such an allergy to shrimp could turn into the kind where you could not breath. So, do not eat it again.
To me, this is more an issue of lack of public education on this subject matter. Teach people what the difference is. Also include what are side effects.
My favorite are the psych patients who come in with a laundry list of all the psych meds that they are supposedly allergic to. Yet I never see a benzo on that list...
Nurse Leigh
1,149 Posts
Well there is a poster digging a huge old hole. GrnTea and others have tried to help but it's not looking good.