[livewell78]

My coworker was administering conscious sedation and informed the doctor that the patients blood pressure was 200/100. The doctor said ok and continued with the procedure. My fellow coworker was just terminated because she didn't stop the procedure. Is this legal?

[putmetosleep]

Originally Posted by livewell78

My coworker was administering conscious sedation and informed the doctor that the patients blood pressure was 200/100. The doctor said ok and continued with the procedure. My fellow coworker was just terminated because she didn't stop the procedure. Is this legal?

I'm not 100% sure, but I think it is legal. I know that if a doc orders something innappropriate/harmful to the pt and the nurse administers it, the nurse can be reprimanded legally. I think the doc should be punished as well though.

What was the procedure being performed? Was there any harm done to the patient/adverse effects of administering the conscious sedation? In my dept we administer conscious sedation for TEEs, and I've never had a doc cancel the procedure due to HTN--however we will cancel them for hypotension, since the conscious sedation can lower BP. Just curious about what the situation was.

How unfortunate for your co-worker, I hope you get some replies from people who know the answer to this for sure.

[putmetosleep]

This might also be a good question to ask your state board of nursing--they should be able to give you straight answers.

[Martinette]

Oh for god's sake and if she had told him to stop he would have probably started berating her and screaming saying "i'm the doctor blah blah blah".

[RealNurseWitch]

It's probably not illegal. Like another poster said, it's probably looked at in the same light as if say, the doctor said to give a patient Morphine, the nurse found out that patient is allergic to Morphine, but she gave it anyway because the doctor ordered it.

I'm scratching my head though, as to how in the world the nurse could have just stopped the procedure if the doctor didn't want to/feel like it was necessary to stop. Furthermore, as a nurse in that situation... I'll be honest with you, I would hope that the doctor knew enough about what he was doing to know if it had actually indeed been OK to go on with the procedure.

What WAS the outcome, I would like to know?

The nurse in the original post needs to seek legal counsel, if she has not already done so.

[RealNurseWitch]

Also....

Were they in the MIDDLE of the procedure, or did this all occur BEFORE the procedure started?

Hindsight is 20/20, but if your coworker felt like it was a dangerous situation, she might have wanted to inform her house supervisor before the procedure began, if the doctor was refusing to cancel the procedure.

[ebear]

I think we need some more details about the situation. What was the procedure and pt's. condition prior to procedure, etc. On what grounds did the hospital terminate her?

If the doc decided to go forward with the procedure, his decision should have overridden the nurse's questioning, unless it was blatant malpractice. She DID notify him of the BP issue. So, I'm not following this... Too much missing.

[Jolie]

It is perfectly legal.

The hospital probably has a policy regarding administration of conscious sedation to patients with unstable vs that was not followed. Hospital policies are violated every day without consequences, so there must be a reason why action is being taken here. Perhaps the hospital had an incident regarding this or another patient. Perhaps Risk Management noticed a trend of unnecessary risks. If administration is under the gun to show that they are taking action to correct a problem, they might even file a report with the BON.

It is the nurse's responsibility to question and refuse to carry out dangerous orders. I understand that would likely cause the physician heartburn, but the BON doesn't care much about irate physicians. Their (and our) duty is to the patient, not the physician and his/her ego. You can always state that you will not given the medication, and offer the physician the option of doing so him/herself, or refuse to administer the medication until the nursing supervisor and/or pharmacy can be reached for a consult. Again, not easy to do, but a means of protecting one's license.

I agree that if the nurse was fired over this incident, then the physician should likewise face disciplinary action.

[livewell78]

thank you to everyone who gave their input. Here are some more details
My co-worker was administering conscious sedation to a patient receiving an epidural steriod injection in our pain clinic. This co-worker let the doc know the bp was high (200/100). My co-worker did continue to give the conscious sedation per the doctor's orders. The versed that was given did bring the blood pressure down. Nothin at all happened to the patient. The patient did have a hx of HTN and some cardiac history(I'm not sure of the details of the cardiac hx). But the patient went home after the meds wore off like normal and my coworker was fired. She did have a few other disciplinary actions that were taken against her for small things (ie. starting a procedure without the h&p being completed). It just doesn't seem right that this situation is what got her fired.

[Zookeeper3]

The problem is that with HTN like that, bleeding is more likely. Not having checked the H&P pre proceedure IMHO, is very serious. If it was for an epidural steriod and the pt. was on coumadin... could have been very serious.

If your facility has a policy as ours does with proceedures, you are not to assist and call the supervisor to back you when vital signs are out of limits. Proceedures sometimes have to be canceled until the pt. status is optomized.

Now termination is very serious.. I'd think that there would be a trail of documentation to back the facility.