Error Number 6. Forgetting to check for a patient's drug allergies

A nursing instructor on clinical rounds with her students checked the Kardex and spotted a new order for an intramuscular (I.M.) injection of penicillin. Since her students needed experience administering I.M. injections, she decided this patient would afford a good opportunity to test their skills.

The instructor assigned a student to give the injection, and together they checked the patient's medication administration record (MAR) against the doctor's original order, written on the patient's chart. They also went over the five "rights" of medication administration-right patient, right drug, right dose, right time, and right route. Everything seemed to check out, so the student gave the injection.

The patient, enjoying all this attention, asked what the injection was. When the student said it was penicillin, he said quietly, "But I'm allergic to penicillin."

The instructor immediately rechecked the chart and MAR. Although the allergy was noted on the patient's health history, neither the chart nor the MAR had been flagged with an allergy alert.

The patient developed a rash and facial swelling from the penicillin, and was given 50 mg of diphenhydramine HCI (Benadryl) I.M. to counteract these effects.

The instructor used this incident to make several points about checking for allergies:

1. When you compare the patient's MAR with the doctor's original order, also check the chart for allergies.
2. If the patient is allergic to a drug, be sure an allergy alert appears both on the MAR and on the front of the chart.
3. Suggest the patient get an armband to identify his allergy.
4. Before administering drugs that frequently cause allergic reactions (e.g., antibiotics, narcotics, aspirin), ask the patient if there are any medications he can't take.

The hospital can also provide an additional safeguard: Many pharmacies maintain drug profiles that include each patient's diagnosis and allergies. The pharmacist compares all new orders with the profile, and so provides still another check for possible drug allergies.