Question about giving Lovenox

[SubSippi]

I'm a new grad, I've been in a step-down/tele unit for about two months now. At my hospital, almost all of the patients are prescribed Lovenox for DVT prophylaxis, even if the patient is mobile and gets out of bed occasionally. People get TED hose and SCDs sometimes, too, but they don't comply because they're so uncomfortable.

Most patients don't say anything about it, they just let me give them their shot. But a lot of times they whine about it, and make it clear they hate those shots. I've also had a couple patients refuse it, saying that the doctor told them they don't really have to have it because they get up and move.

My question is this. For the patients that are mobile, and complain about getting the shot, would it be out of line for me to tell them they have a right to refuse it, and since they get up and move around they aren't at a high risk for getting a DVT? Or should I just keep my mouth shut about it? So far I haven't been holding it unless my patient refuses it without any additional information or prompting from me, but some of them hate it so much I'd hate to keep doing it to them if it wasn't necessary.

Thanks!

[chrisrn24]

I would give it unless pt refuses or it's a wrong order...however with anything a pt is questioning I do remind them they have the right to refuse.

[VickyRN, MSN, DNP, RN]

Definitely advocate to all your patients that they receive this "blood thinner" injection. If you have ever witnessed a patient experiencing a pulmonary embolism, it is terrifying and something you will never forget. Many times, they code and it is very difficult to bring them back. The minor discomfort of receiving the daily Lovenox injection is a small price to pay to prevent a PE. A PE can occur in a patient who is "up and about," as immobility is just one risk factor out of many. Trust me -you don't want a PE to occur on your watch!

[Aurora77]

I work on a post OP floor. We give tons of Lovenox shots. I would never encourage a patient to refuse it. In fact, if they do refuse, I document that I educated them on the repercussions of not taking it. Most of our patients are compliant.

My advice is to keep practicing your technique. The vast majority of the time my patients tell me they don't feel the shot when I give it. Make sure you're going to a nice fatty area and be quick when you insert the needle.

We've had a couple of patients come back with PEs, despite them being compliant with their anticoagulation. They are nothing to risk. A little pain from a shot or a hospital stay coupled with a good chance of death? Not worth it to avoid the shot.

[canadianhungarian]

Educate them if they refuse!!! There is a reason it is given - as a preventative measure. Trust me from experience always advocate to give it!!! I know first hand what is it like to have a DVT then give myself those injections (had to do it x1 week) and I would rather put up with the shot then have a DVT again. Insert the needle fast but give the injection slightly slower then normal - minimizes the stinging and bruising afterwards. Trust me on this!!!! I never got the DVT in the hospital tho mine was a different reason but those levonox shots basically saved my life (prevented it from getting worse so to speak!!)

[VANurse2010]

1. Give education on the indication for the med.

2. It's OK to tell them they have a right to refuse

3. Do NOT tell them that they are at low risk for DVT/PE. That's outside your scope of practice. You're exposing yourself needlessly.

[xoemmylouox, ASN, RN]

This medication is important. Patients always have the right to refuse, but I would not encourage it. That is setting yourself up for a lawsuit if a patient would have a DVT or PE.

[CodeteamB]

Our prophylactic anticoagulants come with a built in "d/c when patient ambulating well" order. This way it is at the nurse's discretion whether to hold the drug.

That being said, there are very few patients that I would qualify as ambulating well. Getting up to the bathroom, or a little cruise around the unit isn't going to cut it. I do use it as incentive to get patients up and about.

As other posters have said, the patient has a right to refuse, your job is to be certain they are making an informed choice. Explain the benefits of the drug, and the risks of not taking it. Then if they refuse I would use that as a starting point for education on activity level.

I would never tell a patient that they would be fine without the med, because I can't know that for sure and it could come back to bite me in the butt.

[blondy2061h, MSN, RN]

I was in the hospital and walking several times a day. I wasn't ordered on any prophy anticoagulant being young, low risk, walkie talkie. Two months later I had two PE's. You can never be too cautious.

[SubSippi]

Thanks y'all, very good advice. I became curious about its necessity after the very doctors who ordered it went back and told the patients they didn't really need Lovenox, but then still didn't order it to be dc'd. Who knows, but I will definitely encourage each patient to take it!

[wooh, BSN, RN]

Thanks y'all, very good advice. I became curious about its necessity after the very doctors who ordered it went back and told the patients they didn't really need Lovenox, but then still didn't order it to be dc'd. Who knows, but I will definitely encourage each patient to take it!

Are the doctors REALLY telling them that though? It might be the doctors told them they're getting it because they aren't moving around as much as usual, and the patients take that as, "I got up to the bathroom, so the doctor said I don't need it."

[dansamy]

Are the doctors REALLY telling them that though? It might be the doctors told them they're getting it because they aren't moving around as much as usual, and the patients take that as, "I got up to the bathroom, so the doctor said I don't need it."

And this is why you should round with your doctors.

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