I Work at a skilled nursing facility as a registered nurse. When I look at the administration record of some of my residents, I see particular nurses do not give medications because the resident’s blood pressure is borderline (e.g., 119/62). But, there is no parameters set by their doctor. I would understand Holding it if their BP or HR is abnormally lower than normal. But there are no parameters. Some nurses hold it, but would not let the doctor/NP know.
Why is that?
And they call every medicine they give “BP meds”, like Carvedilol, furosemide, and HCTZ. There are patients who are prescribed these medications and they’re not taking it’s to specifically treat high blood pressure So, Why?
Places I have worked if you have no parameters it’s an incomplete order and must be followed up on not ignored or “held”. Also if they do t tolerate those cardiac meds well and tank after a 3.125 carvedilol the. I would hold at a 110’s as well especially if they become symptomatic. However, holding meds without parameters, without a reason during report to me sounds incomplete on a lot of ends. House the prescriber for parameters and speak with your colleagues as you why they held it.
This is a dangerous practice for several reasons as others have stated. It’s very rare for me as an ICU nurse to hold someone’s beta-blocker if it’s ordered and when I do I have a discussion with the team notifying them. There are many reasons for this, but many times the med is not just for “BP control” and putting someone into beta-blocker withdrawal is a very real concern.
If a med is being held regularly that is something the provider needs to be aware of- can the dose or frequency be reduced? Can another similar med be prescribed, etc. are all things that need to be considered.
Holding meds without hold parameters is also considered practicing medicine and The Joint Commission would have a field day with this.
I Work at a skilled nursing facility as a registered nurse. when I look at the administration record of some of my residents, I see particular nurses do not give medications because The resident’s blood pressure is borderline (e.g., 119/62). But, There is no parameters set by their doctor. I would understand Holding it if their BP or HR is abnormally lowEr than normal. But there are no parameters. Some nurses hold it, but would not let the doctor/NP know. Why is that? And they call every medicine they give “BP meds”, like Carvedilol, furosemide, and HCTZ. There are patients who are prescribed these medications and they’re not taking it’s to specifically treat high blood pressure So, Why?
Notify the doc, ask for parameters.
A pox on your lazy coworkers for not notifying the doc when there are no parameters. And a pox on the doctors for not giving parameters in the first place.
13 hours ago, Eurobreakstar said:
Places I have worked if you have no parameters it’s an incomplete order and must be followed up on not ignored or “held”. Also if they do t tolerate those cardiac meds well and tank after a 3.125 carvedilol the. I would hold at a 110’s as well especially if they become symptomatic. However, holding meds without parameters, without a reason during report to me sounds incomplete on a lot of ends. House the prescriber for parameters and speak with your colleagues as you why they held it.
maybe you could ask the nurse who did that "hey is there an instance when I should hold a med with no parameters, I like getting a few pointers from people who've been doing this awhile"
you might get an answer like "Mrs Smith's been here two months, she ALWAYS falls out of bed, or off the toilet or her wheelchair, when she receives all her meds AND her BP falls below such and such, and she had dialysis, with 30 patients to keep an eye on, you'd be wise to keep an eye on that or call the Dr for parameters, I haven't had the time. Thanks for asking, you'r e a great nurse ? "
I hold meds. I also document that I held it. I also inform the physician that I held it and why. Usually another dose is ordered or they say OK.
If I have a heart rate of 60-61, I’m probably not giving metoprolol. Lasix will drop a pressure. If my patient is in the 90’s, I’m going to hold it and talk to the physician. It often depends on why it’s ordered.
I don’t feel like you should be judging others when you don’t have the full story.
I hold meds. I also document that I held it. I also inform the physician that I held it and why. Usually another dose is ordered or they say OK.
If I have a heart rate of 60-61, I’m probably not giving metoprolol. Lasix will drop a pressure. If my patient is in the 90’s, I’m going to hold it and talk to the physician. It often depends on why it’s ordered.
I don’t feel like you should be judging others when you don’t have the full story.
So....you are doing what the OP is saying that some coworkers are not doing.
So....you are doing what the OP is saying that some coworkers are not doing.
Where was the judging part?
The judging comes in where it’s a different shift. Is the OP, combing through charting? How does the OP know that no physicians were notified if they were not present? I don’t always document physician notified. I may hold a 0900 med, but mention it later when the physician rounds.
Maybe the patient was symptomatic at the time. Maybe 119 is very low for them. Maybe they live high, but now see an unusually low pressure for them.
There’s lots of scenarios. I hate when other shifts try to pick apart my shift and my decisions. If there is a problem with my practice or charting, it comes from above, not the next shift or a shifts 2 days later.
But you're reading the OP as if its only possible purpose is to criticize.
The OP asked "why" and has received some plausible and reasonable rationales for why such things might happen.
The OP is not criticizing your personal practice.
I can't understand the defensiveness. It doesn't sound like the OP went off and reported these practices, s/he came here and asked "why." It wouldn't be unusual for someone to come here to try to get an idea if what they were seeing was appropriate or not before deciding to raise the topic in the workplace; especially newer nurses (which granted I don't know if the OP is a newer nurse or not).
On 8/9/2020 at 8:31 AM, LovingLife123 said:
How does the OP know that no physicians were notified if they were not present?
Or another question might be why would someone just randomly decide to say that? They just make things up so they can be judgy?
Do you read any of the posts on here that talk about the workload/time limitations involved in working the med cart in LTC? Or any of the posts that give hints about their providers' availability and (often lack of) intimate involvement in what's going on with the LTC residents? There are probably lots of posts here that randomly hit on the idea that LTC nurses are not expected to be calling for every little resident need or irregularlity like you might do in acute care. I thought there was even a post where they were continually told by the employer not to call because the facility had some wacko contract with the medical provider where calls were charged individually and they didn't want to pay for said calls.
I mean, I guess if you think the most likely thing is that the OP made up a story about what s/he thinks is going on here so that s/he could have something to post on a nurse's discussion forum, that's up to you. It doesn't seem like the most likely thing to me.
Lastly, if a med is going to be held, subsequent nurses should be able to ascertain why so that they can follow through on the concern that caused the med to be held and be alert for continued/future concerns. If the OP just made this all up without trying to check the places in the chart that might have given more information, then okay, I'll concede s/he should have checked those areas before coming here to ask "why."
The judging comes in where it’s a different shift. Is the OP, combing through charting? How does the OP know that no physicians were notified if they were not present? I don’t always document physician notified. I may hold a 0900 med, but mention it later when the physician rounds.
Maybe the patient was symptomatic at the time. Maybe 119 is very low for them. Maybe they live high, but now see an unusually low pressure for them.
There’s lots of scenarios. I hate when other shifts try to pick apart my shift and my decisions. If there is a problem with my practice or charting, it comes from above, not the next shift or a shifts 2 days later.
Chiming in here, I would document speaking to the doctor and their input on my report. Why? It may show a pattern of the patient reacting to the medicine, the doctor may feign a memory lapse if something happens down the line, the provider may review the notes and realize a medication change is in order if the current one isn't working for the patient, it helps other nurses working behind you take notice if you're not there to give them information on that patient, etc.
I always chart the change in pt status/med holding, notification of provider, new orders or lack of new orders/provider aware, and patient follow up status post med being held or new med response/if ordered. It shows you assessed, notified the provider, and followed up. Your job is done and it helps with continuity of care for the patient.
I hold meds. I also document that I held it. I also inform the physician that I held it and why. Usually another dose is ordered or they say OK.
If I have a heart rate of 60-61, I’m probably not giving metoprolol. Lasix will drop a pressure. If my patient is in the 90’s, I’m going to hold it and talk to the physician. It often depends on why it’s ordered.
I don’t feel like you should be judging others when you don’t have the full story.
Several nurses take it upon themselves to withhold their meds, not document anything, Or not call the attending (or not tell the provider when they visit).
and many of them incorrectly call any related medication “BP meds” even though many of these particular meds don’t tank blood pressure or heart rate in the first place. Yet, Many of the residents have been on their medications for Years, but they think if they give it to them It’ll harm them so how.
But you're reading the OP as if its only possible purpose is to criticize.
The OP asked "why" and has received some plausible and reasonable rationales for why such things might happen.
The OP is not criticizing your personal practice.
I can't understand the defensiveness. It doesn't sound like the OP went off and reported these practices, s/he came here and asked "why." It wouldn't be unusual for someone to come here to try to get an idea if what they were seeing was appropriate or not before deciding to raise the topic in the workplace; especially newer nurses (which granted I don't know if the OP is a newer nurse or not).
Or another question might be why would someone just randomly decide to say that? They just make things up so they can be judgy?
Do you read any of the posts on here that talk about the workload/time limitations involved in working the med cart in LTC? Or any of the posts that give hints about their providers' availability and (often lack of) intimate involvement in what's going on with the LTC residents? There are probably lots of posts here that randomly hit on the idea that LTC nurses are not expected to be calling for every little resident need or irregularlity like you might do in acute care. I thought there was even a post where they were continually told by the employer not to call because the facility had some wacko contract with the medical provider where calls were charged individually and they didn't want to pay for said calls.
I mean, I guess if you think the most likely thing is that the OP made up a story about what s/he thinks is going on here so that s/he could have something to post on a nurse's discussion forum, that's up to you. It doesn't seem like the most likely thing to me.
Lastly, if a med is going to be held, subsequent nurses should be able to ascertain why so that they can follow through on the concern that caused the med to be held and be alert for continued/future concerns. If the OP just made this all up without trying to check the places in the chart that might have given more information, then okay, I'll concede s/he should have checked those areas before coming here to ask "why."
I’m not defensive at all, so I’m not sure where you are getting at. You are reiterating my point, there are constraints in an LTC so the OP, should not be critiquing everything a previous shift has done.
I honestly don’t get why you attack most of my posts. You do it quite often and I’m not sure why. Numerous other posters posted the same thing I did, yet you want to go after me.
I have 8 years now of ICU experience. I know a little bit of what I’m doing. By no means do I claim to know it all, as we are constantly learning in nursing.
I wish a tiny bit that you would back off of me, instead of feeling the need to slam me for a lot of the responses I make. If you have an issue with me personally, please DM me as I would be glad to answer any questions or clear up this confusion you seem to have about me. But you constantly arguing with my comments takes away from the OP.
There are severe constraints in LTC which is exactly why I don’t think other shifts should question or judge what is happening on a previous shift. If, they feel so inclined, bring it to the attention of the DON. But I am guessing this won’t bode well for the OP.
So, good luck, OP. At some point, you will have to see the bigger picture. Are these patients being harmed? Is this a job you can stay with? Do you need this job to pay your bills? If the patients are fine, and everyone is aware, you are fighting a losing battle. And if you decide to report nurses these “wrongs” in your eyes, you better make darn sure you have the entire story before you start throwing accusations.
thanks for your input.
Eurobreakstar
13 Posts
Places I have worked if you have no parameters it’s an incomplete order and must be followed up on not ignored or “held”. Also if they do t tolerate those cardiac meds well and tank after a 3.125 carvedilol the. I would hold at a 110’s as well especially if they become symptomatic. However, holding meds without parameters, without a reason during report to me sounds incomplete on a lot of ends. House the prescriber for parameters and speak with your colleagues as you why they held it.