Coreg med and no heart rate parameters?

MessyMomma · Mar 21, 2013

Wow...sorry to hear about your termination. It seems kinda' harsh for that one error.

But at our facility, unless there is are stated parameters, we give the med. If it were a situation like you described, I would have to call the MD and ask his wishes as to whether it be given. We are no longer allowed to use "nursing judgment" to hold a med.

ThislittleoneRN · Mar 21, 2013

I am sorry to hear about your termination. I have always gone by the magic number with all blood pressure medication as I would with digoxin. If the HR is

Vespertinas · Mar 22, 2013

I don't understand all these posts where people describe one mistake and then a swift termination. Is the nursing environment really this intolerant or are some people not seeing the bigger picture surrounding their situation?

Maybe even if there IS a bigger picture, the unfortunate RN isn't clued in on it because the manager isn't addressing it and is instead just waiting for a solid issue that can be used as grounds for termination. I've definitely seen the latter...

Morainey, BSN, RN · Mar 22, 2013

Were you passing meds with your preceptor? Or, were you supposed to be passing meds with your preceptor? When I started as a graduate nurse we had to have all of our meds co-signed, I think to prevent issues like this.

cardiacmadeline, RN · Mar 22, 2013

What was the patient's baseline heart rate? Was the coreg a new medication or had the patient been on it previously?

amber7591 · Mar 25, 2013

Yes I feel like they should have clued me in on this, it makes me wonder that this may happen often.you can pass meds on your own but she was right there beside me as I was scanning all the meds.baseline hr was 55-59. No he had been on this med for a while I believe it was ordered bid or tid. Thanks for the comments I've just had a rough week since losing my job. I even started wondering if this was the field for me. I felt horrible, like it was something that shouldn't have happened and maybe I shouldn't be a nurse.I still feel depressed about it all and mad at the same time.

Vespertinas · Mar 25, 2013

So just to be clear, amber, nothing else was brought to your attention that might indicate you were in hot water prior to this?

Hopefully it was so maybe you could make it a learning experience. If not then I am sorry for your situation. You're being taught early on to develop a thick skin and be VERY careful about your practice. At least you should be assured that most places aren't THIS unreasonable. It may be for the best that you didn't stay long!

If this was my first job and I was only there a few months, I wouldn't put this on my resume. But that's me.

psu_213, BSN, RN · Mar 25, 2013

What was the error here. There were no parameters given for the med. One could argue that you should have made a call to the doc. That's about the only issue you could have here.

FWIW, I have seen situations where pt's are beta blocked into the 40s and parameter for the dose is "hold for HR

cardiacmadeline, RN · Mar 25, 2013

I agree with psu, one of my biggest pet peeves is when nurses hold Coreg based on BP and HR and not seeing the big picture. I see his baseline HR was in the 50's and that he had been on it for awhile. I don't know your patients story or clinical picture, but I believe you did the right thing. Your preceptor and other staff nurses on your floor need some education on Coreg! If this was the sole reason you were terminated, I think you were wrongfully terminated.

This is a post I posted a couple of years ago regarding Coreg and why you just don't hold it based on BP and HR alone:

Coreg is a nonselective beta-alpha blocker given in HF to block SNS effects like increased heart rate, contractility, and peripheral constriction, all of which increase oxygen needs and increases the workload on the heart. Coreg is part of the core treatment of HF, with the goal being to decrease the workload on the heart and to maximize the ability of the heart. Coreg decreases heart rate to increase filling time and decreases afterload. So if a CHF'er has SBP in the 90's and this is their baseline while on coreg, I will give it. If it is a huge change from their baseline or they are symptomatic with the low BP, I would call the MD. A lot of CHF'ers have and are tolerant of low BP's and as long as they are tolerating it (have no s/s hypoperfusion or hypovolemia), they should receive their core CHF medications (diuretics, B-blockers, ACE inhibitors). You have to ask yourself if holding the medication would actually benefit the patient, and you can't base that decision on blood pressure alone, you have to look at the whole clinical picture. Also, I have always been taught that coreg therapy should never be interrupted or discontinued abruptly, so I will always call the MD before holding it unless there are parameters written.

turnforthenurse, MSN, NP · Mar 29, 2013

I was always taught to hold a beta blocker if the HR is

When in doubt, call the MD, unless there are specific parameters written.

applewhitern, BSN, RN · Apr 7, 2013

I agree, Coreg is not one of the meds I would hold, simply based on a patient's heart rate. Yes, you do need to look at the whole picture. If there are no written parameters, then call the MD. I am shocked about all the people who say they were "fired" for one mistake.