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.

[subee, MSN, CRNA]

On 12/11/2021 at 7:01 PM, londonflo said:

Yes, You are a professional. The case presented was to HOLD a medicine not switch up a medicine. The remedy to prevent short sightedness is not to call when it is obvious giving the medication will cause more harm than good.  

Then frankly think and act as a professional. 

I sound mean, I agree, but until we will be recognized as a professionals, we need to up our game. Ask any doctor about the calls they receive that shouldn't have been made and you will find out how 'helpless' nurses act, when it comes to medications. 

Are you beating your head against the wall yet with people who respond to your posts without actually reading them?  My first thought abou the original post was that I'd never met a Trazedone that actually make me driwy enough to actually sleep;)

[Hoosier_RN, MSN]

11 hours ago, subee said:

Are you beating your head against the wall yet with people who respond to your posts without actually reading them?  My first thought abou the original post was that I'd never met a Trazedone that actually make me driwy enough to actually sleep;)

I'm wondering if londonflo is reading. I put my original response, with my why and what for. I get the reply that no one said this or that. I never said anyone did either, it was part of my reply as an explanation. In today's litigious society, it's good for the OP to understand the when's, why's, and such. Headbeating sounds painful, I won't participate, londonflo should not either

[JKL33]

I think I'm missing something in this discussion. I hope so anyway. People are talking about so many different things, extrapolating and conflating this and that; talking as if nurses are afraid to temporarily not give a med exactly on time in order to use the delay to communicate with the provider.

Well, the OP did not stipulate any of that and asked a question more on the order of, "hey, if I don't think this patient should have xyz med for my xyz reason, can I just not give it."

It's simple: No. Not without all the other stipulations people have been adding, so....that would be no.

Can a nurse not give a med on time (hold it) until they can...uh...undertake "interprofessional collaboration" with the provider? Of course. And they should have that discussion on a timeline appropriate to that situation.

Must a nurse give a medication when they have legitimate concerns about its appropriateness in a given situation? NO. But they have an obligation to discuss their concerns in a professional manner, as has already been noted--and they need to do that on some kind of appropriate timeline.

I have never understood why some nurses get so frazzled to think that their role is not independent medical practice. It just isn't. That is a different profession.

On 12/10/2021 at 8:33 PM, 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

I think nurses want to make decisions that are within their scope of practice. Not sure what to make of this comment. Perhaps I'm just misunderstanding what you're saying.

[subee, MSN, CRNA]

On 12/13/2021 at 8:20 AM, Hoosier_RN said:

I'm wondering if londonflo is reading. I put my original response, with my why and what for. I get the reply that no one said this or that. I never said anyone did either, it was part of my reply as an explanation. In today's litigious society, it's good for the OP to understand the when's, why's, and such. Headbeating sounds painful, I won't participate, londonflo should not either

My above quote was to London Flo.  Not to you or your post.  It was a generalized statement about multiple posters responding to issues that the OP didn't ever bring up.

[Hoosier_RN, MSN]

2 hours ago, subee said:

My above quote was to London Flo.  Not to you or your post.  It was a generalized statement about multiple posters responding to issues that the OP didn't ever bring up.

I know that, that's why I said londonflo should not participate in headbeating

[subee, MSN, CRNA]

15 hours ago, Hoosier_RN said:

I know that, that's why I said londonflo should not participate in headbeating

Arghhhhh.  Another misinterpretation on my part:)

[FolksBtrippin, BSN, RN]

Yes, you can hold a med and you should hold meds when necessary, but you need to let the provider know. If you give a med inappropriately, that’s bad nursing practice. We don’t follow orders blindly. 

A refusal is not the same thing as holding a med. 

[Guest219794]

On 12/10/2021 at 9:43 PM, MunoRN said:

A nurse who believes a medication should not be administered but administers it anyway because the Physician told them to is failing to meet the requirements of their license.  

I do this every day.  Every day I give meds I believe should not be administered.  

But, I agree with the sentiment, and pick my battles.

 

[JKL33]

2 hours ago, FolksBtrippin said:

Yes, you can hold a med and you should hold meds when necessary, but you need to let the provider know. If you give a med inappropriately, that’s bad nursing practice. We don’t follow orders blindly. 

A refusal is not the same thing as holding a med. 

I think there is some confusion within the thread because the hold/held/holding verbiage has historically been used when a when a (final) decision has been made to not administer a scheduled dose following “interprofessional collaboration.”
 

“We are holding his β blocker for now.”

Or “We held his blood pressure medication all day.”

Holding isn’t referring to the initial “let me not give this right his second so I can speak with the provider.” 
 

The “holding” terminology is to indicate that the medication is not discontinued; it is expected to be resumed at some point, but for now is being “held” following the proper process for holding.

So…according to traditional usage…still can’t hold without one of several stipulations. The informal and applicable definition of holding here includes the collaboration (formerly known as “order”). Can we make final decisions to hold without the collaboration aka order? No. Unless there is a refusal, which as you noted is different. 

[FolksBtrippin, BSN, RN]

4 hours ago, JKL33 said:

I think there is some confusion within the thread because the hold/held/holding verbiage has historically been used when a when a (final) decision has been made to not administer a scheduled dose following “interprofessional collaboration.”
 

“We are holding his β blocker for now.”

Or “We held his blood pressure medication all day.”

Holding isn’t referring to the initial “let me not give this right his second so I can speak with the provider.” 
 

The “holding” terminology is to indicate that the medication is not discontinued; it is expected to be resumed at some point, but for now is being “held” following the proper process for holding.

So…according to traditional usage…still can’t hold without one of several stipulations. The informal and applicable definition of holding here includes the collaboration (formerly known as “order”). Can we make final decisions to hold without the collaboration aka order? No. Unless there is a refusal, which as you noted is different. 

 

We hold meds. I think that verbiage is even used on NCLEX.  Holding a med based on your nursing assessment is not putting a med on hold, which is what I think you’re talking about. 

Not every nurse has the confidence to hold a med when she should. And that’s a shame.

[FolksBtrippin, BSN, RN]

16 hours ago, hherrn said:

I do this every day.  Every day I give meds I believe should not be administered.  

But, I agree with the sentiment, and pick my battles.

 

I’m curious, what is happening there? 

[Hoosier_RN, MSN]

10 hours ago, FolksBtrippin said:

I’m curious, what is happening there? 

If it's like many, pain meds or lorazepam, etc.