Codes against doing cardiac drips on a medical floor?

  1. I work on a "telemetry unit" that does every drip know to man. There are no exceptions to the drips we do, but we are technically considered a "med-surg unit." It is very frequent that we have 5 and 6 patients. I one night had to act as charge with 6 patients while 3 were on drips that I was titration all night long. Are there any regulations against this very unsafe situation?
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  2. 12 Comments

  3. by   All_Smiles_RN
    i dont know about any rules against it... me personally, i would refuse the assignment. or quit the job.
  4. by   Kymmi
    Im also not sure if there are any specific rules regarding drips on telemetry units but I do know in our hospital that other than heparin no drips are titrated on our telemetry or PCU floor. Any patient that needs to have drips titrated for B/P, HR etc are sent to the CCU or ICU. Our PCU/telemetry will take Cardizem as long as its as a set order and not ordered to be titrated. Dopamine is only adminstered on the floor if it is at renal dose and not being titrated etc. Any vasoactive drip titrated is a automatic ICU admission. I think it would be difficult to manage that many patients and attempt to titrate drips effectively. Vitals should really be done q 30 minutes on vasoactives that are titrated otherwise it could be a very dangerous situation.
  5. by   UM Review RN
    Same here as Kymmi. That many patients and titrating drips doesn't sound very safe to me.
  6. by   canoehead
    As far as titrating vasoactive meds I wouldn't do it without Q5min blood pressures, and the ability to watch those BP's and the patient at least that often. I would want the patient in my line of sight, impossible if you have 5 patients. That job sounds dangerous for all involved.

    I'll bet those pressors are going in peripheral lines too, hmmm?
  7. by   CHATSDALE
    i know that this is off subject but: do we owe it to the patient or the familly to tell them that the care they are receiving is not at the level that we would like to give them

    the things that really kill me are the trusting eyes of the family..they did their part , they brought loved one in and now they are in your hands and they breathe a sigh of relieve and look to you to do a miracle and bring mom back fro the brink of death

    maybe a good reason for op to walk away and find a new workplace
  8. by   Dinith88
    Quote from CHATSDALE
    i know that this is off subject but: do we owe it to the patient or the familly to tell them that the care they are receiving is not at the level that we would like to give them

    the things that really kill me are the trusting eyes of the family..they did their part , they brought loved one in and now they are in your hands and they breathe a sigh of relieve and look to you to do a miracle and bring mom back fro the brink of death

    maybe a good reason for op to walk away and find a new workplace
    good point...and just wait till the 'nurse in the family' comes to visit and see's her relative on a pressor thats being 'titrated' on this unit...

    "oh...your mom's in some sort of shock-state...but dont worry, we have these patients here all the time...be right back to check her pressure right after i see my other four patients!..."
  9. by   Indy
    Quote from canoehead
    As far as titrating vasoactive meds I wouldn't do it without Q5min blood pressures, and the ability to watch those BP's and the patient at least that often. I would want the patient in my line of sight, impossible if you have 5 patients. That job sounds dangerous for all involved.

    I'll bet those pressors are going in peripheral lines too, hmmm?
    People that like to run dopamine and dobutamine in hand IV's just make me wanna jump up and down and say bad things! Add that to a patient who's swearing up and down she won't consent to a central line, has no other veins and won't be a DNR. It's enough to give me a seizure.
  10. by   Spatialized
    While I'm not on a medical floor, it is true tele, we run titratable drips. Most common is dlitiazem, which we will titrate to HR in AFib w/RVR, per MD orders. We also have Amiodarone a lot, but it is always going as a continuous, no titration. Nitro, to blood pressure, is the other titratable one, but only to a certain rate, I think it is up to 15mcg/min. We also run Lasix, heparin (titrated based on PTTs) and occasionally Tikosyn.
    On nights we'll usually have 4-5 patients, usually if you have more drips, it will be 4. Everyone is on the monitor, blood pressures are hooked up as well with the results being displayed on the central monitors. If I'm tweaking the drip, I'm right there monitoring, grabbing manual BPs every now and then to correlate. You just stay on top of it. I think our patients are getting the level of care required. If things start to head south, we have Rapid Response and MD only a phone call away.

    Cheers,
    Tom
  11. by   meandragonbrett
    We only titrate in the unit and they'll have an art line as well.
  12. by   Dinith88
    Quote from Spatialized
    While I'm not on a medical floor, it is true tele, we run titratable drips. Most common is dlitiazem, which we will titrate to HR in AFib w/RVR, per MD orders. We also have Amiodarone a lot, but it is always going as a continuous, no titration. Nitro, to blood pressure, is the other titratable one, but only to a certain rate, I think it is up to 15mcg/min. We also run Lasix, heparin (titrated based on PTTs) and occasionally Tikosyn.
    On nights we'll usually have 4-5 patients, usually if you have more drips, it will be 4. Everyone is on the monitor, blood pressures are hooked up as well with the results being displayed on the central monitors. If I'm tweaking the drip, I'm right there monitoring, grabbing manual BPs every now and then to correlate. You just stay on top of it. I think our patients are getting the level of care required. If things start to head south, we have Rapid Response and MD only a phone call away.

    Cheers,
    Tom
    Does Tikosyn come in an IV form? I've only given PO...even with initial loading...

    I agree that most of the drips you mentioned are 'doable' on a tele floor, i think the ones that get people all up-in-arms is the vasopressors. If someone's got no BP they should be in the unit...
    And lidocaine or amio for venticular rhythms i'd want in the unit...(amio for atrial stuff is ok on tele-unit though...)
  13. by   Oncnurse86
    It probably depends on the policies & procedures of your hospital. The floor i used to work on, we could so SOME drips. I've infused quite a bit of dopamine, but we had to transfer pts who needed cordarone drips to cardiac IMCU. Just depends. However, if you're nurse to patient ratio is too high to safety care for your pts on cardiac drips I would look into finding a new job. Its not worth putting your license at stake (and a pt's life!)..you worked hard for it!
  14. by   smoke over fire
    I couldn't tell if you're in California, but on a side note legislation if being worked on to define "what is a tele unit vs a med surg unit". tele units can have very different definitions. I work for a large HMO and we have almost no drips, with the same 4-5 ratio. No vents. Last hospital had simialrly to you drips and vents and one CNA for 25 patients. I quit. I love my coworkers and still keep in touch, but felt like I was the one who needed meds! Ultimately I read that the patient's on today's tele units are the same acuity of those who where ICU in the 70's when the ratio was changed to 1:2. And that's one reason why I changed jobs.

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