Admit Dx HTN urgency & CP & no antihypertensives ordered

[LPN47331]

I had a pt admitted with CP and hypertensive urgency who was also on telemetry. His/her admit BP 200s/100s. C/o headaches. I look @ admit orders and no meds ordered for BP. Just vicodin, tylenol, and anti-emetic. This pt was not on the floor 5 minutes and I called the ER doc who wrote the admit orders and explained the pt's BP was 225/117 and asked if (s)he could order something for his/her BP. ER doc would not give me anything and suggested I call the admitting doc for orders, which I did without any luck. I paged, left messages and called the doc @ home and still no answer. When the pt was in ER, (s)he was given: 3 NTG SL, morphine, vicodin and zofran before his/her BP came down to 190s/60s. I called ER again and finally got an order for some NTG ointment. I'm just wanting some opinions or thoughts on this. Thank You!

[BluegrassRN]

I can't provide you any insight; I just want you to know you're not alone. We experience this, too, in our hospital. Admission for pain with no pain meds ordered. Admit for chest pain with no tele orders. Admit for intractable nausea/vomiting with only zofran ordered. Admit for DKA and a low level ss insulin is all that is ordered.

We simply end up calling the admitting docs (not the ED docs, they absolutely refuse to add any orders once the pt is on the floor, as they don't have privileges once the patient is admitted). I always make sure I tell the doc "Pt X was admitted to you with HTN urgency, BPs in the 200s/100s, however ED did not order anything to control BP". Nurses aren't going to be able to make a change. The docs have a bigger pull in our hospital, they are the ones who are going to have to duke it out with the ED physicians.

I do write up an incident report every time that happens, though. I want it in the official system, that there is some sort of breakdown between the ED and the floors. I suspect the ED docs don't want to be writing admission orders at all; it's fairly obvious they feel the admitting docs should come down and write the admitting orders for their own patients. I think the ED docs write the bare minimum (and I do mean absolute minimum), and *want* you to have to call the primary doc. There is some sort of power struggle going on between ED docs and admitting docs in our hospital, and not writing any real orders is the ED docs' passive/aggressive way of getting a shot in on the floor docs.

[FancypantsRN]

I agree - this happens everywhere. I almost drop from disbelief if appropriate orders accompany the patient to the floors.

Just like I almost drop from disbelief if they are inpatient with HTN and a BP prn with parameters is actually ordered.