call MD if HR <60

[Ehhh15]

Hi everyone, I'm a new grad and just started working on a med-surg tele unit for nights. I had a patient on tele that got bradycardic but not even anything

While giving report to the AM shift, this one nurse saw the admit parameters that said "call MD if HR 100". So the oncoming nurse kinda gave an attitude as to why I didn't call MD. While we were talking, an MD who was handling the patient asked an unrelated question, so I brought up that the pt was bradycardic last night but would usually return to normal. The doctor didn't even care about this.

Was I right for not calling an MD for that HR? I know parameters were in place but we should also always look at the patient and not just the numbers.

[dream'n, BSN, RN]

If parameters are specified, I call. Covers me, covers any issues that may arise. I worked Oncology and would have system generated critical lab values that the hospital wanted called to the Drs within a certain amount of time. Most of my chemotherapy patients had critical lab values come back, but with numbers that were steadily improving. Even thought I KNEW the Dr would not order anything, I did what PPs recommend. I informed the Dr of the result and then requested a change in lab value orders to call about in the future. The Drs eventually got sick of the calls and remembered to override the system order during admission.

Also, since you missed the order until the morning, I recommend making it a habit to check all current patient orders as early as possible in the shift. Sometimes you won't believe the orders that have been missed and it saves you from seeing it at 5 AM and thinking "Oh S***!"

[NurseSpeedy, ADN, LPN, RN]

"Why are they on tele?"

"So we can watch them die in real time."

I have literally had tele call me and ask, concerned, "Um, is room 100 a DNR? They just dipped into the 20s"

Me, "Yes, and he was downgraded to CMO 30 minutes ago"

Tele, "Oh, that's good because he's gone now. He just stopped while you were speaking"...now, if the patient was a full code, this would have been a really bad day. I have never been in a code where the tele desk calls me with an issue. The code has already been called because I saw the change first when I walked in the room and my first thought is "OH SH@$!". Hate days like that.

[SouthpawRN]

Assuming they are not an athlete. I would think a rate less than 60 means they may have switched from SA node stimulation to AV node stimulation for cardiac contraction. Would this be the reason the MD wanted to be notified. Also that is contraindication for giving beta blockers, is it not??? Could it indicate that the therapeutic dose of one of the patient's meds has been exceeded? Sorry Dumb student questions I guess. I figure if a doc wants to be woken up at 2 am to know this I will be happy to oblige.

[KatieMI, BSN, MSN, RN]

Oh, the fun and pleasure to see my fellow nurses going bananas after seeing my BP 83/45 (yeah, my low normal, no pads are needed, just tell me where your coffee machine is, and let's make it hot and full )

I would advice you to call only for the reason of you being new and recent hire. After you get somewhat more experienced, it would be a good and sound thing to do to sit together with the doctors and maybe with management, and eliminate those silly parameters once and for ever. Doing so greatly improves life for everyone involved.

[NICU Guy, BSN, RN]

Oh, the fun and pleasure to see my fellow nurses going bananas after seeing my BP 83/45 (yeah, my low normal, no pads are needed, just tell me where your coffee machine is, and let's make it hot and full )

Your blood is not pumping through your veins, it is more like a "lazy river ride" through your veins.

[RNKPCE]

If that is a standard order where you work maybe the order needs to be changed and read "notify MD for symptomatic bradycardia less than 60" or "50". On telemetry many patients have heart rates below 60, some from meds, some because they are fit etc. Same thing for heart rate above 100. Not unusual for a pneumonia patient to have a heart rate between 90-110 if they are running a fever.