Monday, July 18, 2011

Monday morning hospital rounds

I love it when I see contradictory stuff like this in a chart:

(click to enlarge)

20 comments:

Frantic Pharmacist said...

Yep, I love this kind of thing. On Friday I filled 240 Percocet for someone whose 'allergies' included oxycodone. Looking back over his med list I could see this was approximately his 50th fill, so I cleverly disregarded the 'allergy'. See it all the time, though!

Anonymous said...

As a transcriptionist, I would have flagged that. But I can't promise anything after that. I am not sure half my flags aren't ignored anyway.

Single Female Doc said...

Lawyers love it too!! :-P

Anonymous said...

Another transcriptionist here. I see this way too often. It doesn't help that some docs put them in as an aside in the H&P or PMH. Hello, guys, separate heading, capped and bolded! We do everything but put them in flashing neon lights. Doesn't anyone check?

Tori said...

Another transcriptionist here. Our problem at our facility is that the allergies are put on the EMR by the medical assistants, and the doctors don't see them or review them (not sure which) at the time of their dictations. Therefore you get the allergies that drop into the report and medications the doctor dictates. I think I see this kind of oops at least once a week.

Bendy_Clutz said...

I think there should be an "intolerant of" section in addition to allergies.. a patient telling me vicodin is an allergy because it makes them throw up bugs me..but severe vomiting is a noteworthy side effect/intolerance that probably should be listed somewhere important..

Moose said...

Medication making someone throw up may not sound like a side effect, but let me tell you, when you're screaming in pain and your blood sugars are all over the place from the stress of the 50 out of 10 scale pain, discovering that oxycodone makes you barf like the kid in the Exorcist (and, gee, has no effect on the pain) does NOT help your health any.


There's another side effect where the "kindly" nurse tells you you can't have any other pain meds, since you just had some. In me, apparently, oxycodone can cause murderous rage.

PA Honeybee said...

This makes those of us in pharmacy SO MAD!!!!!! I get PAs with the med requested listed as an allergy and wonder if anyone even made a connection to this egregious error. Then as I dial the office I cross my fingers that it was listed as a mistake.

Anonymous said...

As any experience nurse, doctor, pharmacist knows; half the listed allergies are total and utter crap.

Laura said...

As my fellow transcriptionists have already noted, we see this stuff regularly and try to flag it. Our concern is that the EHR is going to eliminate those checks and balances that have been taken for granted, and largely gone unnoticed, as more and more physicians do their own documentation with no QA in place. The problem is that doctors are constantly interrupted-nurses, pagers, phone calls. It is no wonder that doctors cannot complete a thought or finish a sentence.

I hope somebody figures out that the EHR is only going to compound documentation errors and propagate those errors exponentially (compared to paper records in physician-office silos). MTs have been silently flagging this stuff for years but we are being taken out of the picture more and more these days.

Anonymous said...

Was the diagnosis 'allergic reaction'? Or, perhaps, the patient suffered a head injury from falling down due to precipitous syncope related to anaphylaxis?

I always get a kick out of looking over ER charge sheets for methylprednisolone and diphenhydramine and perhaps a little famotidine, and the diagnosis as 'allergic reaction' but allergies listed are 'NKA', like maybe we should avoid giving this parson any more of what to avoid an emergency trip to the ER in the middle of the night?

pharmacy chick said...

Geez, we see this ALL the time. patient allergic to Tylenol given vicodin. patient allergic to Oxycodone given percocet. makes you wonder if the allergy profile is really worth much really....

Anonymous said...

Maybe the doctor really hates the patient and is hoping they will go into fatal anaphylactic shock?

Sara said...

Pharmacy Chick- They did that to me, which is why I've become just like Moose in my murderous rage. I know that projectile vomiting is 'technically' NOT an allergy, but for the health and safety of everyone involved in my care, I list it as one, because when you can digest it, it won't help make the pain go away.

Anonymous said...

Best ever I've seen is a type 1 diabetic having insulin listed as an allery! Saw that today in a chart and laughed out loud.

Baffled said...

Sounds like the PA I saw at a big name pain clinic. After I told him I have serious neurologic reactions to SNRIs (sunburn type pain all over including inside the mouth) he prescribes me Savella for FM pain. At least I'm smart enough to look this stuff up before I go to the pharmacy to order it.

The Mother said...

But if you ignore the stupid allergy info, and something, ANYTHING, happens to the patient...

Shannon said...

As a clinical hospital pharmacist, my first impression would be that the patient doesn't want generic Dilantin, so he listed it as an allergy. How close to truth is that?

Truthfully, if you fill it without questioning, that will be the one that has a horrible reaction and you'll have to live through a root cause analysis and friendly discussions with a few directors.

And when you call to question the allergy, the nurse and physician will act like you're an idiot.

There's just no winning in our big happy dysfunctional health care system.

Anonymous said...

Back again, the best allergy I've ever seen was IV saline. So how come you're not dead already?

Mindi said...

As a former transcriptionist, this made me laugh too. I can't add to anything that the other MT's said, other than it never stops... Just keep typing what's dictated and flag, flag, flag...

 
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