IV Lopressor on the med/surg ward?

Nurses General Nursing

Published

Hi, I would like to know if anyone has been giving IV lopressor on the med/surg floor. Our surgeons have decided recently that the nurses on my unit need to give IV lopressor to post-op pt's. The pt's are to be put on tele and monitored by ICU nurses one floor below us. WE have to do VS q 5min x15min, then q15 min x30,then q 30min. The order is to give q 4hrs, so you are constantly in the pt's room. Our nurse pt ratio is 6-1, so this is very difficulty. I have been a nurse since 1981 and I have never been expected to do this on the ward.My experience has always been these pt's need to go to the ICU. And on top of this the pt was on an insulin drip as well, which in my experience that the pt's on insulin drip need to be in the ICU as well. Has the standards of practice changed??

Specializes in Mixed Level-1 ICU.

"Requiring this on Med/Surg units is just part of the bigger pattern of increasing demands but not decreasing the ratio. I'm sure eventually it will be commonplace on MedSurg units. Today's MedSurg patients are yesterday's ICU pts. It's ridiculous. And that is why I don't do floor nursing anymore"

Ditto to the 10th power!

Up Vote Up Vote ×
Specializes in Stepdown progressive care.

Wow, I can't believe how frequent you're required to check vs after giving lopressor. It's almost as much as when you hang blood. lol!!

I work on a step-down unit with 4:1 on nights and we give IV lopressor all the time. We usually check bp before giving and have parameters for not giving it. We frequently give it for patients who have high hr's and most people have it ordered prn for bp. We also take insuling gtts and other gtts that have protocals but we are also expected to titrate drips according to the drs orders and our floor policy.

Up Vote Up Vote ×
Specializes in Trauma ICU, MICU/SICU.
Hi, I would like to know if anyone has been giving IV lopressor on the med/surg floor. Our surgeons have decided recently that the nurses on my unit need to give IV lopressor to post-op pt's. The pt's are to be put on tele and monitored by ICU nurses one floor below us. WE have to do VS q 5min x15min, then q15 min x30,then q 30min. The order is to give q 4hrs, so you are constantly in the pt's room. Our nurse pt ratio is 6-1, so this is very difficulty. I have been a nurse since 1981 and I have never been expected to do this on the ward.My experience has always been these pt's need to go to the ICU. And on top of this the pt was on an insulin drip as well, which in my experience that the pt's on insulin drip need to be in the ICU as well. Has the standards of practice changed??

We give IV lopressor all the time and the pt. doesn't necessarily need to be on telemetry. I agree with all others q5min VS is impossible on a med/surg floor. As for insulin gtts we get those all the time as well. Our ratio is also 6:1. It is very doable, but we don't do frequent VS. When would the poor pt. rest? What is the rationale? The onset of lopressor is immediate and the peak is 20 minutes. So I would think if anything would happen, it would be almost immediately. As for the tele on another floor that is completely unsafe and if the "all powerful surgeons" want their patients on a telemetry than they need to go to a tele floor.

Up Vote Up Vote ×
Specializes in CT ,ICU,CCU,Tele,ED,Hospice.

i have worked 2 tele floors where we gave lopressor freq.we had protocols we did vs prior to giving and 15 min after thats it and it was q 6 not q 4.yes as part of policy pt was on tele .it would be given for various reason inc hr pts usually on it but postop and npo ,etc .we also had natrecor gtts,heparin renal dopa insulin and dilt gtts.all with protocols .it is not poss for med/surg nurses to do that freq of vs .but the pts don't need icu.as far as tele on another floor and the pts on yours WRONG .the liability is huge on all sides .if the pt needs tele pt should be on tele floor .protect your license.of course pt on monitoring me monitoring hr during and after administration.

Up Vote Up Vote ×
Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
IV lopressor somehow makes a pt ICU status???

No it doesn't. However, the protocol the original poster describes q4h is not possible, or at the very least a reasonable expectation of a nurse with a ratio of 6:1.

Up Vote Up Vote ×

I do not think you all have enough respect for Lopressor. I work ICU and give lopressor frequently and monitor them very closely while giving it, both the blood pressure but more importantly the heart rate, I have seen patients heart rates drop down into the 30's and once even went asystole. I can't believe this med is being given on unmonitored patients and taken so casual.

Many med-surg patients today end up being ICU patients tonight..that's why we always have a bed open for them.

Up Vote Up Vote ×
Specializes in cardiac med-surg.
We give IV lopressor all the time and the pt. doesn't necessarily need to be on telemetry.

yikes !!!!!!!:nono:

Up Vote Up Vote ×
Specializes in Rehab, Med Surg, Home Care.

I work a Med/Surg Tele floor. Most of the pts we have that end up requiring Lopressor IVP have already been put on Tele. However there is a portable monitor we bring to the bedside to monitor a pt not already on Tele. If they are on Tele, we require another nurse to sit at the Nurse's station and watch the monitor. However, there is no formal monitoring after the med is administered.

Up Vote Up Vote ×
I do not think you all have enough respect for Lopressor. I work ICU and give lopressor frequently and monitor them very closely while giving it, both the blood pressure but more importantly the heart rate, I have seen patients heart rates drop down into the 30's and once even went asystole. I can't believe this med is being given on unmonitored patients and taken so casual.

Many med-surg patients today end up being ICU patients tonight..that's why we always have a bed open for them.

Agreed, insulin is no joke either.

Up Vote Up Vote ×

Wow! Lopressor is very powerful, patient needs to be monitored, VS need to be monitored, and orders for problems need to be addressed as protocols suggest. Insulin is powerful too, so yes, a nurse with 5 other patients, possibly one who is demanding or medically fragile, would have difficulty in meeting these orders. Ratio should be 4:1 and that would be pushing the limit if acuity is high.

Up Vote Up Vote ×

At our 200-bed community hospital, IV Lopressor cannot be given on the unmonitored M/S unit, the pt. must be in at least our PCU. The PCU admission criteria states that pts must be on the monitor at all times, and the ratio is 1:3-4. Our hospital has a list of what drugs/drips may be given on the different units - does yours have such a list? You might want to check with your manager or director for the policy on this. Sometimes docs just start ordering things that aren't necessarily in line with policy. I think it's asking a lot of you guys to have to take frequent vitals with so many patients. I've never done VS that frequently when giving Lopressor IVP to monitored pts- just VS before and VS 15 min or so afterwards. Routine VS are q 4 h anyway. Besides, if your pt develops symptomatic bradycardia, are you equipped with the time and expertise to deal with that? If you don't feel comfortable, you should have a long talk with your manager.

Up Vote Up Vote ×
WE have to do VS q 5min x15min, then q15 min x30,then q 30min.

Do you mean q 5 min x3 then q 15min x 2 then q 30 min?

Up Vote Up Vote ×
+ Add a Comment