Adenosine on stepdown unit

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I work on a cardiac stepdown unit in a large hospital. Traditionally we have not given adenosine without a physician present. Our physicians are wanting to put together a protocol that would allow the nurses the push adenosine without a physician. Is this acceptable practice in your institution? Does anyone have a protocol? Thanks

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Specializes in ER.

We in the ER use it on a regular basis...Our protocol states our MD needs to be at the bedside...I don't think it should be any other way, despite its short half life...I think it's just safer to have the MD present should anything go wrong at all...I think if the doctor wants it given, the patient is obviously in some sort of distress to begin with that may need an upgrade in care either to the unit or to be started on cardiac meds or drips. I say they should be present...

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Specializes in Tele, Home Health, MICU, CTICU, LTC.

Being a new nurse with a background in EMS...I look at this situation from 2 perspectives. I think that if the protocols are set up it is not a problem to use adenosine without a physician present. But only if you have ACLS trained nurses to give the medication and monitor the patient. We give adenosine in the prehospital setting without a physician present. The systems I have worked in have not even required us to contact medical control prior to giving it. Some may say that is unsafe but adenosine is an ACLS drug and we learn how and when to use it during ACLS. Just my opinion.

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Specializes in ER.
Being a new nurse with a background in EMS...I look at this situation from 2 perspectives. I think that if the protocols are set up it is not a problem to use adenosine without a physician present. But only if you have ACLS trained nurses to give the medication and monitor the patient. We give adenosine in the prehospital setting without a physician present. The systems I have worked in have not even required us to contact medical control prior to giving it. Some may say that is unsafe but adenosine is an ACLS drug and we learn how and when to use it during ACLS. Just my opinion.

You are also talking about a situation where the patient care is 1:1 ratio...and you don't keep the patient long after that...Of all the step down units I know of...that isn't the only patient the nurse will have....So either there are multiple other patients in the area being ignored while the patient is being monitored, or the patient getting the adenosine isn't going to be properly monitored while the nurse attends to his/her other patients...I'm not saying it good never be done...but Rome wasn't built in a day either...

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Specializes in Community Health Nurse.

I think it should only be allowed to be given in the icu units (be they medical, cardio, or other icu units).........PERIOD!!! It should not be allowed to be given on a unit where the patient is not receiving one on one care, or the patient's room does not have the capabilities of monitoring a patient that critical. Just my two cents. :)

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Specializes in ER.
I think it should only be allowed to be given in the icu units (be they medical, cardio, or other icu units).........PERIOD!!! It should not be allowed to be given on a unit where the patient is not receiving one on one care, or the patient's room does not have the capabilities of monitoring a patient that critical. Just my two cents. :)

Well, we do give it in the ED, and we definitely don't have a 1:1 ratio, BUT we have doctors there that are immediately available in the case of a problem...and I'm not against giving it in the SDU setting, just I think a doctor should be present.

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Specializes in Med-Surg.

I gave it in neuro step down, I was waiting on an ICU bed, which sometimes takes a while. Our cardiac step down gives it as well, because I've transferred patients there who have orders to give it. We don't have physicians present when we give it.

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I have been called from the CCU to tele to give Adenosine. There were no unit beds and the pt needed to be treated. I think that was the appropriate thing to do. It made the tele nurse more comfortable and the pt received the meds they needed. I charted my actions a post assessment and stayed at bedside for 30 minutes until the telenurse said she was comfortable. The CCU nurse manager watched my unit pts while I was at tele. We had the most awesome nurse manager at the time, everything that was needed to be done with my pts was done and documented. I think nursing would be a lot better if we had true on hand managers such as her.

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Specializes in Community Health Nurse.
Well, we do give it in the ED, and we definitely don't have a 1:1 ratio, BUT we have doctors there that are immediately available in the case of a problem...and I'm not against giving it in the SDU setting, just I think a doctor should be present.

Oops! Sorry! Didn't mean to leave ED out...just didn't think of ED at the time I wrote it, but of course it should be okay to give in ED. :)

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I work on tele and it started with the MD having to give it, then MD having to be in the house and now we can just give it. I have never had to give it myself but have been around when another nurse has given it. Personally I think it is quite scary. We give it infrequently on my unit thankfully. But it does work well and quickly. Of course we are ACLS trained and have a monitor/defib/pacer at bedside.

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I worked in a small ICU with stepdown attached to it, we nurses float back and forth. We give adenosine without the doctor present all the time. the pastient has to be "hardwired" to a bedside monitor.

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I worked in a small ICU with stepdown attached to it, we nurses float back and forth. We give adenosine without the doctor present all the time. the pastient has to be "hardwired" to a bedside monitor.

What is the nurse patient ratio for the stepdown patients?

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