A pharmacists review of a patient medication regimen is never complete without a thorough evaluation of the patients allergy history. Unfortunately our hospital information system suffers from the inability to prevent people from being human and making mistakes. Our clinical information system permits ‘free texting’ of allergy information, resulting in misspelled drug names and therefore allergies that aren’t electronically checked against medication orders. You know the old saying: garbage in, garbage out.
At our facility, allergy information is collected by nursing staff at the time of admission. While competent and intelligent, nurses are not generally in tune with the intricacies of taking a good drug allergy history; they have other pressing matters to deal with. As a result the accuracy of drug allergy information located in the patient’s medical record is often less than complete.
Pharmacists on the other hand are interested in everything related to medications, which includes allergies. Most patients don’t know whether or not they’re allergic to a medication, much less what the details are surrounding the allergy. Believe it or not, not all medication allergies are, in fact, allergies. Some perceived allergic reactions can be classified as an adverse reaction, a drug intolerance or simply an expected side effect.
If you get stomach upset from aspirin that’s not an allergy. How about if I fall asleep after taking a Valium? Definitely not. Well, what if I feel dizzy with my new beta-blocker dose? Nope. I get constipated when I take my morphine. Take a stool softener. What if I turn red and can’t breathe after taking penicillin? Yep, you’ve got an allergy.
Did you know that food allergies can affect how you tolerate medications? No. Well they can. For example, if you’re allergic to eggs you may not be able to receive certain vaccines and immunizations, and if you have a severe peanut allergy you should be careful with certain inhalers used to treat asthma and COPD. While not as glamorous as a good medication allergy, this is important information.
The trick with any good allergy history is to dig deep into the matter. Pharmacists, and other healthcare professionals, need to know what medication was taken, when it happened, what the reaction was, how long after taking the medication, how long the reaction lasted, whether or not the patient has taken any related medications and how they were tolerated, etc. It is imperative that pharmacists have this information if they are to make accurate decisions regarding drug therapy. Technology alone can’t do this.
During my fourth year as a pharmacy student at UCSF I was assigned to a general medicine team as part of my clinical rotations. The team consisted of an attending physician, a chief resident, three junior residents, two medical students and one pharmacy student; me. Every so many days this particular team would be responsible for the patients admitted to the hospital through the emergency department. Part of my job was to obtain a detailed medication history from every patient admitted to our service. The medication history included detailed information on the patient’s allergies. You wouldn’t believe the stuff I found by questioning patients. Of course, after taking the history I would enter all the information into the hospital information system for the rest of the medical team.
This brings me to my point; no matter what advances are made in technology, a change in practice in necessary to bring about a safer way to collect allergy information from patients. The best way to accomplish this is to move the pharmacist away from the physical pharmacy and into the trenches where they can interact with the patients. This is especially true in high-risk areas like the emergency department where patient information is first collected. I realize that computer technology is great, but at this time it cannot replace a good pharmacist. However, it can help a pharmacist do his job better and more efficiently. Just a thought.