In my ER, we're required to do preg tests before giving Toradol. Does anyone else do this?

[ReWritten]

I've only been in the ER for 2 months, but curious to other's reply to this. In my ER, we're required to do preg tests on all females (unless they've had a hyst) before giving Toradol. Does anyone else do this?

Last week I had a pt come in with alot of pain, and my doc ordered Toradol for her. I decided to go ahead and draw it up, but my coworkers argued with me stating I absolutely couldn't give it until we ran a preg test, my doctor overheard the argument and stated to go ahead and give it and that he's never heard of this rule.

Thoughts? Comments?

[mwboswell]

Yes, all NSAIDS are limited in pregnancy.

Toradol (ketorolac) is a "C" in 1st and 2nd trimesters and "D" in 3rd trimester.

...however, besides that fact, ANY female pt who has the possibility of even getting a prescription at d/c, should have a documented pregnancy test. There are few category "A" (IE: safe) meds in pregnancy. So even when they come in w/o an abdominal problem, just the fact that your MD/NP/PA might write a Rx - go ahead and get the preg test. It only takes one bad outcome to make a bad day.

-Mark Boswell

MSN FNP-BC CEN CFRN CTRN CPEN NREMT-P

"Support CEN Certification and Your Local ENA"

[murphyle, BSN, RN]

We generally wait for the HCG to come back before giving Toradol, but recent events have started to make the rules a little more... bendy in certain cases. For example, you're caring for a 55 y.o. female with chief complaint of hematuria, dysuria and left flank pain 10/10; she has hx of kidney stones, states she's menopausal, and states she's faithful to her husband who's had a vasectomy. By policy we still would have to wait for her to pee before giving any medication at all, be it Toradol or Tylenol (policy dictates that any female between the ages of 9 and 59 gets a preg test, except when documented that she's had a total HSO, before we do anything).

In the past this was much easier to enforce, as HCGs came back from the lab very quickly (usually

With that said, back to our poor lady with the presumptive kidney stone. Knowing that it'll likely be hours before you get an HCG back on her and the odds against her being pregnant are about 10,000:1, are you going to medicate her or make her wait? You're mandated to follow the hospital policy (no meds before HCG results), but you're also mandated to advocate for your patient (documented pain must be controlled). Which imperative wins?

*cue Jeopardy music*

[babynurselsa, RN]

If you check your drug references it is contraindicated in pregnancy. We do ucg first.

Toradol is also contraindicated in early pregnancy.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Taking Toradol during labor can increase the risk of bleeding during childbirth. Do not take this medication during pregnancy unless your doctor has told you to.

This medication can affect fertility (your ability to have children). Do not take Toradol while you are trying to get pregnant.

Toradol can pass into breast milk and may harm a nursing baby. Do not take this medicine without telling your doctor if you are breast-feeding a baby. Do not give this medicine to anyone younger than 18 years old.

[Lunah, MSN, RN]

Good grief, murphyle ... can't you guys get a little bedside dip kit to address that issue? There is nothing "STAT" about 4 hours!!

[babynurselsa, RN]

We used to be able to do dip urines and hcg in the ER way before CLIA regs. Not anymore.

If your lab is taking 4 hours to get labs back I would be writing a vriance each and every time. That is not stat and can be way dangerous. There should be no reason especially on a test that is complete in under 2 minutes.

[murphyle, BSN, RN]

Lunah and babynurse: Oh, we've been burying the lab in concern audits, and so has all the rest of the house (lack of STAT lab service goes over just as badly in the ICUs, OR and Labor & Delivery as it does with us). Laboratory Services, in turn, hates the new software just as much as we do, and they've been routinely writing up Information Technology for lack of software support. Moreover, as babynurse brought up, we can't do POC urine dipsticks, or any POC testing other than finger-stick blood glucoses, due to CLIA regs. The lab situation has gotten quite a bit better over the last few weeks, though - that is to say, urine pregs now "only" take 30 to 45 minutes... :flmngmd:

The end result has been a major downturn in the use of Toradol in the female population generally. It's become too much of a hassle and risk.

[thelema13]

We check all womens HCG unless postmenopausal or hysterectomy. I make sure a qualitative is back before pushing most meds. Toradol is generally not given to females in our ED.

[xtxrn, ASN, RN]

I given toradol all the time on the med-surg floor I work on and have never checked a pregnancy test.

Usually by the time they get to the floor, most females of child-bearing age have already had a pregnancy test. :)

[Larry77, RN]

To me it's never been a big deal to get a urine HCG before we give Toradol. If they come in with Abd px or flank px we are getting urine anyway.

We do not have a specific "policy" stating that we have to have an HCG before we give it but that is the standard of practice...just like checking for allergies before you give a med.

[carolmaccas66, BSN, RN]

Pg tests on every female (even older ones w/out hyster etc - you never know!) No meds given until this comes back clear or otherwise. Ever.

Check with your NUM/DON I suppose.