Holding HS Meds

brownbook · Jun 25, 2019

I do not know the routine or protocol of special care units. You mentioned that in other units you "we're instructed to" hold the medications.

In regular acute care hospitals you cannot NOT give a med without notifying the doctor. I hope the "we're instructed to" on the other unit is backed up with written protocol.

We're any of these meds ordered PRN?

Unless special care units have some written protocol or policy, a doctor must be notified anytime a med (or treatment) is not given.

Newgurl17, CNA, LPN · Jun 25, 2019

22 minutes ago, brownbook said:
I do not know the routine or protocol of special care units. You mentioned that in other units you "we're instructed to" hold the medications.
In regular acute care hospitals you cannot NOT give a med without notifying the doctor. I hope the "we're instructed to" on the other unit is backed up with written protocol.
We're any of these meds ordered PRN?
Unless special care units have some written protocol or policy, a doctor must be notified anytime a med (or treatment) is not given.

Meds were scheduled

brownbook · Jun 25, 2019

Okay, so scheduled meds, what I said applies, the doctor must be notified, UNLESS there is a written protocol for patients in your special care unit?

Newgurl17, CNA, LPN · Jun 25, 2019

1 minute ago, brownbook said:
Okay, so scheduled meds, what I said applies, the doctor must be notified, UNLESS there is a written protocol for patients in your special care unit?

Usually we let the RN know what's going on, they give us direction, we continue to monitor, then notify the physician via fax, unless the resident's condition is more urgent, then the RN gives the on-call physician a call. In other instances, the nurse lead (an LPN or RN usually) may have us trial holding medications, like risperidone, if a resident is too sedated, then we fax the physician of the trial was effective to discontinue the order

brownbook · Jun 25, 2019

Great, that explains a lot. Your protocol is to notify the RN, (and document that you did). Did you notify the RN about holding the trazadone and seroquel?

I can completely understand why you held them, but it's still up to the doctor to decide if it's appropriate to hold them.

I doubt that missing one dose of either meds is a problem. But almost all psychiatric mood altering meds, even when prescribed for sleep, cannot be stopped abruptly.

Newgurl17, CNA, LPN · Jun 26, 2019

7 hours ago, brownbook said:
Great, that explains a lot. Your protocol is to notify the RN, (and document that you did). Did you notify the RN about holding the trazadone and seroquel?
I can completely understand why you held them, but it's still up to the doctor to decide if it's appropriate to hold them.
I doubt that missing one dose of either meds is a problem. But almost all psychiatric mood altering meds, even when prescribed for sleep, cannot be stopped abruptly.

Yes, RN was notified. Resident was agitated this morning during AM care but not hs care this evening. More alert this evening than she was yesterday evening.

Glycerine82, LPN · Jul 12, 2019

I would have held the trazodone but never the seroquel without an order.

downsouthlaff, LPN · Jul 21, 2019

It sounds like this woman may be over medicated and CMS has come out with new regulations to try to reduce the use of antipsychotics through GDR and monitoring programs. But you have to remember that as a nurse you can never hold a med without an MD order or a standing parameter. Nurses can not instruct other nurses to hold meds. We do not practice medidicne. Now the appropriate thing to do In that situation would have been to notify MD of the over sedation and try to get underlying problem addressed not just hold the med. That’s the hallmark of nursing. Good luck to you

downsouthlaff, LPN · Jul 21, 2019

On 6/25/2019 at 5:24 PM, brownbook said:
Great, that explains a lot. Your protocol is to notify the RN, (and document that you did). Did you notify the RN about holding the trazadone and seroquel?
I can completely understand why you held them, but it's still up to the doctor to decide if it's appropriate to hold them.
I doubt that missing one dose of either meds is a problem. But almost all psychiatric mood altering meds, even when prescribed for sleep, cannot be stopped abruptly.

But even though the RN was notified, unless there would be some kind of standing arrangement between RN and MD, an RN telling an LPN or another RN to hold a med without an order from an MD is still not permissible as nurses at any level other than APRNs cannot practice medicine. Deciding when to hold meds with no standing parameters is practicing medicine.

brownbook · Jul 21, 2019

1 hour ago, downsouthlaff said:
But even though the RN was notified, unless there would be some kind of standing arrangement between RN and MD, an RN telling an LPN or another RN to hold a med without an order from an MD is still not permissible as nurses at any level other than APRNs cannot practice medicine. Deciding when to hold meds with no standing parameters is practicing medicine.

I agree completely.... I mentioned in my previous replies that a doctor must be notified. It seems that the protocol in this special care unit was the LPN notifies the RN. I told the LPN to document that the RN was notified.

Newgurl17, CNA, LPN · Jan 7, 2020

This is totally an unrelated maybe? Question and may sound dumb... But I must ask... What if a resident is on scheduled laxatives and they were known to have diarrhea either on days or on evenings. Would you still have to contact an MD to hold those scheduled laxatives, or would you go ahead and hold them? On our EMAR, we do have the option to hold medications? Also I can't remember if I mentioned this before when I typed this topic but at this facility, we only contact the MD's in an emergency?