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  • 1.  Allergy Removal

    Posted 21 days ago

    Hello, 

    Curious as to practice at other institutions- are your nursing staff (RN, LPN, MA) allowed to remove a patient allergy from the EHR, or does this responsibility fall to a provider? 

    Thanks!



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    [Melissa] [Budnick]
    [Membership and Association Services Manager]
    [AAACN]
    [Pitman] [NJ]
    [856-256-2326]
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  • 2.  RE: Allergy Removal

    Posted 21 days ago
    Hello,

    Our RNs are removing incorrect allergies from the EHR, yes. 

    We push the top of license work!


    Thank you,

    Cindy

    Cindy Garrett, RN, MBA, BSN, AMB-BC
    VP Ambulatory Quality

    Dignity Health Medical Foundation

    Dignity Health
    A member of CommonSpirit


    CA Region Ambulatory Quality
    CommonSpirit Health™

    530.919.5467 (mobile)

    Executive Assistant:  Lori Balcoff

    916.379.2902

    Lori.Balcoff@commonspirit.org


    Quality Assistant:  Courtney Cardenas

    Courtney.Cardenas@commonspirit.org


    DHMF CSPS Connections Page

    Caution: This email is both proprietary and confidential, and not intended for transmission to (or receipt by) any unauthorized person(s). If you believe that you have received this email in error, do not read any attachments. Instead, kindly reply to the sender stating that you have received the message in error. Then destroy it and any attachments. Thank you.





  • 3.  RE: Allergy Removal

    Posted 20 days ago

    FYI  from a regulatory standard, allergies and reactions are to be updated at each visit. So sites are not measured or deemed deficient if nurses remove or update the allergies....



    ------------------------------
    [Melissa] [Budnick]
    [Membership and Association Services Manager]
    [AAACN]
    [Pitman] [NJ]
    [856-256-2326]
    ------------------------------



  • 4.  RE: Allergy Removal

    Posted 18 days ago

    Hello,

    Registered nurses should not delete or remove allergies from a patient chart.  Only a licensed provider can do this because it is not within the scope of practice for a nurse to make a diagnosis or decide something is not a diagnosis.  An allergy is essentially a medical diagnosis like any other chronic medical condition.  An RN can amend or clarify an allergy, but removing it altogether is the responsibility of a provider. 



    ------------------------------
    [Melissa] [Budnick]
    [Membership and Association Services Manager]
    [AAACN]
    [Pitman] [NJ]
    [856-256-2326]
    ------------------------------



  • 5.  RE: Allergy Removal

    Posted 17 days ago
    I feel the need to disagree with the comment about RNs removing allergies from a patient chart.
    If an allergy has been entered in error i.e. a patient states they are "allergic" when in reality they have a sensitivity to a drug or a food, this is not a medical diagnosis and can be removed by a RN. I have encountered many individuals who do not fully understand the difference between an allergy and a sensitivity and automatically assume their symptoms are allergic in nature. The vast majority of the time, allergies are entered into a patient's chart by a nurse or medical assistant, not an MD, NP or PA, during the initial visit. That entry is based upon what the patient states they are allergic to. This is not diagnosing an allergy.
    There also have been instances wherein a patient is "diagnosed" with an allergy, especially to an antibiotic and it turns out not to be such. I saw this multiple times in the Allergy/Asthma practice I worked in where patients were told by a physician in the past to avoid a medication or a food and after performing a challenge, it was discovered there really was no allergy at all. While it is true that oftentimes the MD would delete the so-called allergy, the nurses were allowed to do so as well.
    I had a personal experience in this respect with amoxicillin. During my mid-20s, I was put on the drug and after taking it for 7 days, I developed a rash on my arms. One of the physicians where I worked assumed it was an allergy so I avoided penicillin for three decades which was completely unnecessary.

    Heather A. Wilkinson BSN, RN, AMB-BC






  • 6.  RE: Allergy Removal

    Posted 17 days ago
    I agree. Upon intake RN or other staff ask allergies, and are supposed to reconcile at each visit. I have never had an issue with staff updating allergy information. Many times an allergen is listed on the H&P yet the patient reports NKDA
    This is patient historical information not diagnosis




  • 7.  RE: Allergy Removal

    Posted 16 days ago
    Let's not forget that in EPIC, and I am guessing other EMR systems, the allergy section isn't just for ALLERGIES. It includes INTOLERANCE and CONTRAINDICATIONS. 

    Over the years I have seen medications or foods entered as ALLERGIES and made corrections when necessary.  Lactose intolerance is one example. Some medications can't be taken when a patient is on a certain medication, hence a contraindication. 

    And please add what symptoms or reactions the patient experiences with these medications or foods, and the severity level. I often have to fill in these blanks. 

    Environmental/seasonal/plant allergies and insect allergies should be included. Think of it as being part of the patient's medical history. There's a reason that patient is on antihistamines or walks around with an EpiPen.

    And nurses can click on Allergies VERIFIED, especially right before administering any medications or vaccines. It's for patient safety, and let's face it, covers your RN license.





  • 8.  RE: Allergy Removal

    Posted 14 days ago

    Thanks everyone for the great discussion. Agree 100% that nursing can add allergies to the chart. We are having conversations around the implications of removal and what level of training and education is needed to perform that level of clinical decision making if it's not an erroneous entry or something of that nature. Appreciate the different perspectives and everyone's thoughts!

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