Coreg med and no heart rate parameters?
- 0Mar 21, '13 by amber7591I just started as a nurse on a medical floor, I was on orientation. I had a coreg to give and the heart rate was 52, there was no parameters entered by the physician so I went ahead and gave it. Unknown to me, my preceptor came up to me later and said I wasn't suppose to give that because his heart rate was too low. No one told me on the floor that 60 was their magical number that was too low to give for coreg. (I still have to look up their policy and procedure) I was taught in nursing school that if its below 50 the general rule is to hold it if there is no parameter on it. I looked it up in my Davids drug book and it says the same thing, to hold it if its under 50. Consequently I was fired this past Monday due to this error. What is everyone's thoughts?
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- 0Mar 21, '13 by MessyMommaWow...sorry to hear about your termination. It seems kinda' harsh for that one error.
But at our facility, unless there is are stated parameters, we give the med. If it were a situation like you described, I would have to call the MD and ask his wishes as to whether it be given. We are no longer allowed to use "nursing judgment" to hold a med.
- 0Mar 21, '13 by ThislittleoneRNI am sorry to hear about your termination. I have always gone by the magic number with all blood pressure medication as I would with digoxin. If the HR is <60, hold the med. I would definitely recommend going to pubmed.com and reading up on some of these medications and their parameters. Best of luck to you on your next nursing adventure!
- 9Mar 22, '13 by VespertinasI don't understand all these posts where people describe one mistake and then a swift termination. Is the nursing environment really this intolerant or are some people not seeing the bigger picture surrounding their situation?
Maybe even if there IS a bigger picture, the unfortunate RN isn't clued in on it because the manager isn't addressing it and is instead just waiting for a solid issue that can be used as grounds for termination. I've definitely seen the latter...
- 0Mar 25, '13 by amber7591Yes I feel like they should have clued me in on this, it makes me wonder that this may happen often.you can pass meds on your own but she was right there beside me as I was scanning all the meds.baseline hr was 55-59. No he had been on this med for a while I believe it was ordered bid or tid. Thanks for the comments I've just had a rough week since losing my job. I even started wondering if this was the field for me. I felt horrible, like it was something that shouldn't have happened and maybe I shouldn't be a nurse.I still feel depressed about it all and mad at the same time.
- 0Mar 25, '13 by VespertinasSo just to be clear, amber, nothing else was brought to your attention that might indicate you were in hot water prior to this?
Hopefully it was so maybe you could make it a learning experience. If not then I am sorry for your situation. You're being taught early on to develop a thick skin and be VERY careful about your practice. At least you should be assured that most places aren't THIS unreasonable. It may be for the best that you didn't stay long!
If this was my first job and I was only there a few months, I wouldn't put this on my resume. But that's me.
- 5Mar 25, '13 by psu_213What was the error here. There were no parameters given for the med. One could argue that you should have made a call to the doc. That's about the only issue you could have here.
FWIW, I have seen situations where pt's are beta blocked into the 40s and parameter for the dose is "hold for HR < 45." 60 is most definitely not a magic number, and if nurses on this unit feel that 60 is the definitive cut off level, they need some (re)education in the matter.
- 6Mar 25, '13 by cardiacmadelineI agree with psu, one of my biggest pet peeves is when nurses hold Coreg based on BP and HR and not seeing the big picture. I see his baseline HR was in the 50's and that he had been on it for awhile. I don't know your patients story or clinical picture, but I believe you did the right thing. Your preceptor and other staff nurses on your floor need some education on Coreg! If this was the sole reason you were terminated, I think you were wrongfully terminated.
This is a post I posted a couple of years ago regarding Coreg and why you just don't hold it based on BP and HR alone:
Coreg is a nonselective beta-alpha blocker given in HF to block SNS effects like increased heart rate, contractility, and peripheral constriction, all of which increase oxygen needs and increases the workload on the heart. Coreg is part of the core treatment of HF, with the goal being to decrease the workload on the heart and to maximize the ability of the heart. Coreg decreases heart rate to increase filling time and decreases afterload. So if a CHF'er has SBP in the 90's and this is their baseline while on coreg, I will give it. If it is a huge change from their baseline or they are symptomatic with the low BP, I would call the MD. A lot of CHF'ers have and are tolerant of low BP's and as long as they are tolerating it (have no s/s hypoperfusion or hypovolemia), they should receive their core CHF medications (diuretics, B-blockers, ACE inhibitors). You have to ask yourself if holding the medication would actually benefit the patient, and you can't base that decision on blood pressure alone, you have to look at the whole clinical picture. Also, I have always been taught that coreg therapy should never be interrupted or discontinued abruptly, so I will always call the MD before holding it unless there are parameters written.