holding BP/HR meds

BittyBabyGrower, MSN, RN · Mar 31, 2006

Since I work at a teaching hospital and there is always someone around, we do tell the doc that is covering that we are holding it. But, if you have specific guidelines that cover you if you hold it then I don't see why you have to call and tell them, unless it is really, really low!

KAW1962 · Apr 1, 2006

Where I work I know the cardiologists pretty well, and through experience I know when they want it given or held. For instance, most of the docs will want you to give lopressor if the SBP is greater than 100; a few of them want it given if SBP is greater than 90. Coreg on the other hand, I generally don't hold unless their BP is really low, but if I have any doubt at all I ask them to write parameters and they usually oblige. I think it's standard practice to hold Dig for hr less than 60. Just like labs--one cardiologist likes to be called if the K+ is less than 4.0. I work on an ortho floor and try to get the cardios to write parameters on the meds simply because a lot of our post-op patients carry a low bp the first couple days after surgery. It avoids repeat calls from multiple staff members and saves them a lot of aggravation.

suzanne4, RN · Apr 1, 2006

In the ICUs now, hold parameters for Beta Blockers can be as low as 80 systolic, if it a cardiac patient. So best bet is to always get it i writing.

Just to cover yourself, it is always a good idea to have it in writing. Do you have a book of standards that your physicians want followed if they are not around, or if it is an emergency? Great idea to have on each of your attendings. It is usually called "Standing Orders."

Hold parameters for specific meds can be included here, unless they order otherwise. It could also be in the same book as to what to do in certain cases, which drugs to give before calling them, etc. Automatic procedures if the patient is having chest pain, etc.

steelydanfan · Apr 1, 2006

If a med is ordered, and you withhold it for any reason, you are legally bound to notify the doctor in the absence of parameters.

To do anything else is practicing med without license.

Yeah, they hate the calls, but thety will probaly be more careful to write parametes in the future.

What I REALLY hate is the docs who write for an ACE inhibitor, NTP, Lasix and a beta blocker while the patient is also on Dop, Dob, and neo.

Gee, do I hold the meds that I know will lower the BP while he's on pressors, and try to wean the pressors down, or do I assume that he wants to try to lower the work of the heart while supporting a dry pump?

C

TennRN2004 · Apr 1, 2006

If a med is ordered, and you withhold it for any reason, you are legally bound to notify the doctor in the absence of parameters.
To do anything else is practicing med without license.
Yeah, they hate the calls, but thety will probaly be more careful to write parametes in the future.
What I REALLY hate is the docs who write for an ACE inhibitor, NTP, Lasix and a beta blocker while the patient is also on Dop, Dob, and neo.
Gee, do I hold the meds that I know will lower the BP while he's on pressors, and try to wean the pressors down, or do I assume that he wants to try to lower the work of the heart while supporting a dry pump?
C

I agree, I had a similar situation at work the other night. Had a patient who was getting amiodorone PO BID (he had been cardioverted for post op AFib a week before). He had a feeding tube, but it got pulled and wasn't to be placed until in the am, and he was NPO for failing swallow study. I went ahead and called cardiology and got the official order it was okay to hold the med, even though how am I going to give it with him being NPO and no feeding tube to crush and put it in. Also, even knowing his levels should have been okay to miss a dose of the med, I didn't want him to go into A fib again, and someone notice I had held a dose of the drug and get upset because cardiology wasn't notified. If you don't have it in writing, you can't read their minds. Don't assume they want or do not want it given unless you have it in black and white.

Luckily, for our patients on Dopa/Dob we do have orders under our beta blockers to hold these if pt is on beta stimulating drugs, it just makes sense.

zacarias, ASN, RN · Apr 1, 2006

This is my opinion, but this is something that comes by more easily with experience.

If there are parameters for holding a medication, that is great. If there are no parameters and I feel I should hold it, I will. I work nights and will not call the doctor for that unless the patient is symptomatic or the problem is severe that I think he/she should be notified.

Remember that nursing is a job that requires critical-thinking and while we don't practice medicine, we do need to practice reasonableness and appropriate autonomy.