Holding BP Meds and contacting MD

[LeahSunshine]

Hello,

I'm a new grad at my first nursing job. I'm technically still on orientation but am allowed to pass meds. I have a patient that goes to dialysis and tends to have low BP. I got in morning report that the on-call was contacted for low BP and and order obtained to hold all BP meds for the night and overnight shift and re-evaluate in the morning. He has an order for Metoprolol in the morning, hold if BP is lower than 100/60, and then in the afternoon he gets Midodrine and Cardizem. In the morning his BP was 108/78 so I gave his Metoprolol, but when I checked his BP in the afternoon and it was 80/40. I couldn't remember what Midodrine was, but the previous shift held that so I checked with a more experienced nurse to ask if it's for BP and she said yes, but I didn't know that it increases BP and she didn't mention that either. So I held both afternoon meds, but then I got home and looked it up and I think I should've given the Midodrine for that. I also consulted with another nurse and the unit manager to let them know what the patient's BP was and what meds were held and asked if I should call the on call PA and they said that he has a history of low BP and it's normal because of his dialysis so that was fine and there was no need to contact the on call. When I handed off report, the next nurse said I should have callled the on-call to report that his BP was low again and that I held the meds.

The communication here is terrible and I get different ways of doing things from everyone I ask and all the different people I've oriented with. It also doesn't help that everyone walks on eggshells when the PA is here and they only want to call him if it's a dire situation because he's really snappy and rude. But anyway should I have given the midodrine and should I have talked to the PA, either about the previous night's order or the afternoon meds being held? I just need some guidance on this (and probably many other things, because I don't get that guidance where I work).

Thank you!

[mrsboots87]

The first thing you should have done (and always do in the future) is look up the med you don't know. Don't ask another nurse. You are responsible for what you give and hold and "well so and so told me this" just doesn't cut it. That is basic nursing 101. If you had given the midodrine and his BP was still that low, then calling the PA would have been a good idea to see if he would like any other med adjustments or new orders.

Since you didn't give the midodrine, it may be a grey area of a med error. And probably should have called anyway to inform the PA.

Next time when you don't know, look it up for yourself. You should be doing that anyway and only asking if you can't find the answer or if it's an emergency and you need an answer right away.