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?
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’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.
She is not critiquing. She is just asking a question.
Holding meds without hold parameters is also considered practicing medicine and The Joint Commission would have a field day with this.
This is what I was going to say.
The "why" is that nurses should not blindly give medication if their gut and situation tells them not to. The buck stops with us when passing medications.
However, MDs should always be made aware and we should always document this and cover ourselves. Many times I will do this and notify the doc when they come in as it's not an emergent call. They can tell me to give the medication, give me parameters, or most often agree that the medication should have been held. Then I will write an order to hold, or document that the MD is aware. But if they aren't aware, they are thinking the medications they orders are being given and effective.
With holding medication is practicing medicine without a license.
I will say I do get frustrated with coworkers that hold medications for "borderline" BPs such as 119/62 (you're example) at 6AM and I come along with their 10AM meds and they are 150/80. 119/62 is not low and might be a sign that their medication regime is effective and should be maintained. Again, that really isn't our call at the end of the day, it's on the prescriber.
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.
I am sorry if I have been unfair. I reviewed some posts to see when I might have last responded directly to you, and as far as I can tell it was on a thread where someone asked a patient care question and in doing so they categorized a medication incorrectly. Your entire comment was to point out the error. Others did too, I guess you just happened to be first and I responded in the OP's defense.
It is your prerogative to answer however you wish on any given topic, of course.
ETA: It looks as if out of your last ~ 50 posts, I have liked 3 and directly responded on two separate topics including this one.
The decision to hold a med is based on the specifics of the situation.
Nurses can and should hold medications sometimes for a variety of reasons.
If you want to criticize a particular instance of holding a med here, then present us with all the clinical information.
But If you want to make an argument that nurses should never hold meds without parameters, that's wrong.
WOW!......I think the point was made quite clear. In skilled nursing. The nurses should not just hold an order. If they feel as thought the BP is too low they must call a provider for approval, and she didn’t seem to be criticizing.
smile!
On 8/9/2020 at 7:48 PM, Kooky Korky said:
I don't think she's judging. She's just asking.
She is not judging. Her tone is quite clear. She is asking for advice and guidance.
Kooky Korky, BSN, RN
5,216 Posts
I don't think she's judging. She's just asking.