Pharmacy-controlled documentation of drug allergies.

The implementation of a pharmacy-enforced policy for documenting drug allergies is described. After two incidents at a 600-bed teaching hospital in which patients experienced severe allergic reactions to drugs, an audit was conducted to evaluate the existing drug allergy documentation policy. Physicians documented allergies in medical charts and treatment orders for 68% and 78% of patients, respectively; no initial drug orders contained this information. Nurses documented allergies in admission assessments, medication records, and charts for 71%, 61%, and 15% of patients, respectively. Only 2% of pharmacy computerized drug profiles contained allergy information. A new policy for drug allergy documentation was instituted. Physicians provide allergy information on the first written drug order. Nurses independently solicit allergy information and check it against that provided by the physician. Pharmacists enter the information into the patient's drug profile. If the information has not been obtained, the drug is not dispensed. Repeat audits two months and one year after the policy was put in place showed significant improvements in the completeness and accuracy of drug allergy documentation by pharmacists and physicians. In general, documentation by nurses did not improve to the degree found for pharmacists and physicians. A policy that gave pharmacists the primary responsibility for ensuring that drug allergy information was obtained before drugs were dispensed was effective in improving allergy documentation by physicians and pharmacists.

Effect of personal pain experience on pain assessment.

The purpose of this study was to determine the effect of nurses' personal pain experiences on the assessment of their patients' pain. The sample consisted of 134 registered nurses employed in three Midwestern hospitals. In response to a personal pain history questionnaire, pain with headache, menstrual distress and dental events were cited most frequently. Most also reported that a family member had experienced pain in their presence (cancer, surgery, orthopedic injuries). Responses to the Standard Measure of Inferences of Suffering (Davitz & Davitz, 1981) showed significant differences between intensity of pain experienced by the nurse and overall perceived patient psychological distress. Furthermore, the intensity of pain experienced by the nurse was the only variable that predicted significantly perceptions of patients' physical suffering and psychological distress. While additional study is warranted, the findings support the notion that nurses who have experienced intense pain are more sympathetic to the patient in pain.