Can you hold medications without a doctor's order?

[Guest878640]

Like insulin or for example if someone had a head injury and you hold trazadone so that symptoms of head injury isn't mistaken for side effects of the sleep aid.

[Hoosier_RN, MSN]

You should have orders for the insulin-I've never seen insulin orders without or a hospital without a p&p to cover. Otherwise, regardless of med, I'd call MD for order to hold (hold med until after call and document well), if I had good reason to believe it needs held. If MD states to give anyway, make sure to document that too

[CalicoKitty, BSN, MSN, RN]

I believe as nurses, we have a responsibility to hold medications that seem unsafe. BUT, the provider needs to be aware. So, I guess there 'needs' to be a protocol or doctors order. But, there have been several times when a nurse feels a medication is unsafe, and may even refuse to administer it and basically tell the provider "you can give it".

[guest1143647]

When a patient refuses  a med, I just state patient refused. 

[Been there,done that, ASN, RN]

5 hours ago, Runsoncoffee99 said:

When a patient refuses  a med, I just state patient refused. 

Please expound. If you are in peds.. Wouldn't many of the little ones refuse?  The doctor would need to be notified for sure with a peds case.

 

[LovingLife123]

You always have to inform the physician and get their OK to hold a medication.  Many meds have hold parameters for these situations, but you just can’t decide Willy nilly to hold a med.

[MunoRN, RN]

You should always inform the Physician of your concerns regarding a medication, but ultimately whether or not you administer the medication is up to you.  That of course doesn't mean you aren't then liable for any adverse effects that result from withholding the medication if it wasn't reasonably justified.  

You aren't just allowed, but required, to not administer a medication if it's clearly inappropriate.  If you gave the medication inappropriately then you would be held liable for the consequences, but keep in mind if you refuse to give it you'll also be held liable for the consequences if that decision was not warranted.

[vintagegal, BSN, DNP, RN, NP]

I’ve very rarely had to hold a med. I let the provider know the reason, and in all the cases I’ve had they’ve DCd and put them on something else. 
 

[Tweety, BSN, RN]

On 12/9/2021 at 10:13 AM, CalicoKitty said:

I believe as nurses, we have a responsibility to hold medications that seem unsafe. BUT, the provider needs to be aware. So, I guess there 'needs' to be a protocol or doctors order. But, there have been several times when a nurse feels a medication is unsafe, and may even refuse to administer it and basically tell the provider "you can give it".

This.

An example would be you holding an antihypertensive medication for a low blood pressure.   Obviously the correct thing to do but if you don't inform the physician you are technically practicing medicine without a license.  Plus the MD thinks all is well with prescribed medications.

We are educated professionals and don't follow orders blindly, but we also are in a collaborative practice.  If it's prudent to hold a medication, then do so.   I don't call the doc right then and there, but cover my butt when the MD rounds.  

[JBMmom, MSN, NP]

Some medications have a parameter in the administration instructions for holding, like sliding scale insulin. I wouldn't inform a provider or get an order for that. However, some say hold medication AND inform provider if held. 

For medications that do not have hold parameters I confirm with MD at some point that medication is okay to be held based on whatever reason I feel it shouldn't be given. 

[londonflo]

21 hours ago, LovingLife123 said:

You always have to inform the physician and get their OK to hold a medication

We will never be a stand alone profession with thinking like this. The point is to have a clear reason to withhold a medicine that is based on documented vital signs or other measurable indicators that show the drug is not warranted. From some of the comments on this and other threads, I get the feeling that many nurses do not not want to make independent decisions, rather  they want back up from the MD>

[LovingLife123]

47 minutes ago, londonflo said:

We will never be a stand alone profession with thinking like this. The point is to have a clear reason to withhold a medicine that is based on documented vital signs or other measurable indicators that show the drug is not warranted. From some of the comments on this and other threads, I get the feeling that many nurses do not not want to make independent decisions, rather  they want back up from the MD>

No it’s not.  I’ve often called a physician over meds and labs asking if they want to hold.  I’m done cases where I thought to hold, the physician wanted it given.  It’s not my scope of practice to make that decision.  I don’t write the orders.  
 

Also a physician will want to know about a change in the patients condition that they don’t require that med anymore.  
 

Don’t be short sighted on what all it means to call a physician and discuss holding an order. I’m seen as a professional.  That’s not something I worry about when I call to see if I should hold lovenox or a BP med.  Sometimes you need to switch up the medication.  Am I supposed to decide which med to look professional?