Critical Meds on MEDSURG

ZASHAGALKA, RN · Aug 15, 2006

These drugs belong on a tele stepdown unit.

If not being 'titrated', all of these drugs can be given with competent observation by a tele nurse on a tele unit.

NONE of these drugs should be given in an environment where tele is not on the SAME unit and by nurses not trained in the cardiovascular implications of said drugs.

Is your staff competency validated to take care of CHF, dysrhythmic, and ACS patients?

At a minimum, I would ask your manager WHERE in the competency grid the staff is validated to use and command these drugs and HOW such competencies are going to be created and maintained.

And then, I'd humbly ask how ratios are going to be limited to take into account the increased acuity inherent in these drugs.

With a little research (I recommend Amer Assoc of Critical-Care Nurses, aacn.org), you ought to be able to arm yourself with some ammunition that your risk manager cannot ignore.

Not to mention the cost in human catastrophe, it simply isn't cost effective to save a few grand on staffing and units 'through-put' at the price of a multi-million dollar lawsuit.

~faith,

Timothy.

rninme · Aug 15, 2006

Agree with Timothy. These are not drugs that I would want to be giving on med surg. ICU/SCU/TELE/ED...yes....staff are trained to give and monitor these medications. To give these medications in what is essentially going to be an unmonitored floor...irregardless that they will have tele monitors on since that unit is on a completely different floor.....is a risk management nightmare in the making. Good luck....it's not something that I would want to take a part in.

msn2008, MSN, RN · Aug 15, 2006

What option will be granted to those intelligent nurses who refuse to give these drugs due to their own (recognized) incompetence? Who will be doing the necessary inservices and competency testing? What is the time lag between noting a cardiac arrythmia by a tele tech and getting the message to the bedside nurse? What do the cardiologists think about this? What does the nurse practice and education council think about this?

Just a few questions I would ask if this were to happen at my facility!

Celia M, ASN, RN · Aug 15, 2006

On our Med/Surg/TELE floor we give Amiodarone, Lidocaine, Dopamine, Dobutamine and Natrecor. These drugs cannot be titrated for effect (this automatically makes the pt ICU, we are a small hospital with no SDU), sometimes the patients are DNR, if that is so they may not be on tele, but the majority are. All of the nurses who take tele patients have ACLS, all the nurses working on the floor have taken an arrythmia class, can read strips and pass a competency in Telemetry. These patients you are talking about belong on a tele floor except in the rare case where they are DNR and even then it would be better for the patient and the staff for them to be cared for on a floor where the nurses are familiar with the drugs and their side effects etc. Good Luck Celia

JHUBRAIN · Aug 15, 2006

On our Med/Surg/TELE floor we give Amiodarone, Lidocaine, Dopamine, Dobutamine and Natrecor. These drugs cannot be titrated for effect (this automatically makes the pt ICU, we are a small hospital with no SDU), sometimes the patients are DNR, if that is so they may not be on tele, but the majority are. All of the nurses who take tele patients have ACLS, all the nurses working on the floor have taken an arrythmia class, can read strips and pass a competency in Telemetry. These patients you are talking about belong on a tele floor except in the rare case where they are DNR and even then it would be better for the patient and the staff for them to be cared for on a floor where the nurses are familiar with the drugs and their side effects etc. Good Luck Celia

All great points. The nurse will have to be ACLS to do these. Inservices will be done with a yearly compentencies as well. Great conversation.

Thanks to all