Beta-blocker administraion error?

[Bosco15]

Hello fellow nurses.. Need some advice,

I am a new nurse (6 months) in a ICU. I administered 2 beta blockers (metoloprol 50mg and coreg 6.25mg) to a pt that had SBP of 190, HR 150. I checked with another anor nurse about administering all 4 bp meds total and was told to give them. I separated them in to two administrations on at 21 and the other at 22. Was it wrong to administer 2 beta blockers. I didn't even realize it until after administer them. Just curious?

[nic900]

Don't worry-we commonly give those 2 meds together but you should always check the efficacy of any intervention. So...bp/hr.

[simboka]

Well what was their vitals after admin? SBP 190, hr 150, sure sounds like they needed them, so where's this doubt coming from?

[Bosco15]

I didn't give all the info. My pt was s/p cardiopulmonary arrest. The pt was unstable since she arrived. Right at the second hour after the admin of the second set of different BP meds which included the second beta blocker the BP dropped and hr went down and went in to another code. All the other nurses said that thie type of pt was already heading towards this and the BP meds didn't do this to the pt. We brought the pt back after the first code. It went on all night though. The Dr just pointed out that I gave two beta blockers. THat is why I starting questioning the administration of them. Her bp was 168 and HR of 145 at the second admin of the BP meds. I feel torn over this case and want to learn the correct actions. I know that I should have spread out my BP meds. I wasn't sure of the effect of two beta blockers would have?

[GilaRRT]

This should make you feel better:

[Multicollinearity, BSN, RN]

I was taught to give coreg and another beta blocker two hours apart, and never at a closer interval. That's in a stable patient, though. I have no idea about critical care & this.

[Bosco15]

Cool program. What is it called? I appreciate the advice. It is hard not to feel bad when a pt condition goes down hill.

[Bosco15]

Thanks for all the info.. It is good to know!!!

[cookienay]

Granted I work ED, not ICU but here is my thought...

The meds were ordered, there were no contraindications at the time of administration. So, you followed the MD order and administered the meds. Sounds to me like you were acting as a prudent nurse and your doc is being a little passive-aggressive and looking for someone to blame.

The physician should be familiar with standard med times at your facility and if he/she wanted them administered differently it should have been noted.

Yes, you are responsible for safe med administration but the physician is responsible for the meds ordered. you did fine, IMHO.

[whichone'spink, BSN, RN]

This should make you feel better:

Hey, what app is that? I have Nursing Central and it doesn't have anything like this.

[GilaRRT]

Hey, what app is that? I have Nursing Central and it doesn't have anything like this.

It's epocrates. You can get it for iPhone, iPad, iPod Touch, Windows mobile and I believe Blackberry devices. I assume it is available for the Android platform as well.

[Ahhphoey]

I'm sure I've given these meds around the same time frame before. I would have done just as you did and waited an hour between meds or called pharmacy to double check if they could be given together. Like someone else mentioned, the doc may have been playing the blame game. Then again, during and after every code we evaluate all potential causes or factors that may have led up to the code, so he may have been just throwing out a potential factor, not necessarily pointing fingers. Either way, you used good judgement to question the administration of both meds and carefully monitoring and spacing out administration. Don't beat yourself up over this too much.