How do I know what BID, Daily Meds to hold before OR?

[mandaaRN]

Hi, I'm a new grad and landed a new job. I'm still on orientation and am slightly confused about medication administration before the OR and dialysis. One of the nurses was trying to explain to me to hold BID meds and give the second dose when the patient returns from the OR, meaning the patient only recieved one dose of that medication for the day. I need help on understanding this concept. Also, which meds to hold or give before the OR? Same for dialysis, since pretty much every medicine gets dialyzed out. This includes, insulin/ IVP/ IV meds/ PO meds. I've been stressing myself out over this, I just don't want to make a mistake. Thanks everyone!

[Been there,done that, ASN, RN]

Holding meds before OR .. and .. on dialysis patients is quite complicated.

You are wise to question the protocol.

As you on orientation... this information should be provided to you .. in writing and in practice.

If your preceptor is not making it clear for you, document that.. and ask nursing education to clarify EVERYTHING.

[Tait, MSN, RN]

Consult your facilities protocol, call the OR/dialysis and ask their preference, take into account the MD (our cardiac docs wanted all cardiac meds given before OHS), and ask the other nurses on your floor. Start a cheat sheet and every time you learn a new preference write it down. Eventually you will have most of your every day meds down and will only have to research oddities and new meds :)

Best of luck!

Tait

[Double-Helix, BSN, RN]

Have you looked for your facility's written policy regarding this? Or discussed it with your nurse manager? This will probably vary from facility to facility and it's best to find out what your own facility's policy is.

Last adult floor I worked on our policy was to hold all medications the morning of the surgery except for a beta-blocker, if prescribed.

[MomRN0913]

Before the OR the patient is usually NPO. If the docs want meds given, they will say "give meds with sip of water" Anticoagulats should be held before surgery, and the doc usually writes for it. Cardiac patients going for a simple procedure, or cath lab or open heart will have give cardiac meds with sips of water orders.

As for HD, hold the BP meds 2 hours before HD. If there are vitamins and supplements , they can be held until afterwards. It also depends on the time HD is scheduled. HD nurses are very knowledgable regarding this. Not all meds are dialyzed out....... It never hurts to ask.

[CharmedJ7]

This definitely seems like a policy and/or order thing. Pre-OR, the order set has a space for docs to specify which meds, if any, they want given prior to OR. All other PO meds are held, IV usually given. If I'm unsure I'll talk to the team.

For HD, they just changed our policy. We used to send meds with the pt to HD, but now they tell us to go ahead and give them before except for once a day abx which should wait.

With both it depends on WHEN they are going. I'd say look at your policy and when in doubt, double check with the MD.

[nurseprnRN, BSN, RN]

doesn't anybody know that you have to know what the effects of the meds are, why they are given, what side effects they have, and how that would affect the planned procedure? in the case of dialysis, are they dialysed out or not? seriously? this isn't merely a protocol thang, there's a reason for it. find out.

[beckster_01, BSN, RN]

^ I agree, it totally depends on the situation, what procedure they are having, etc. Our cardiac surgery patients have a very clear protocol. With our vascular patients it varies, but usually they are okay if I give meds with sips of pills.

Dialysis nurses may correct me, but on my floor we NEVER give BP meds unless instructed before dialysis. Most patient's BP drops during/after dialysis. Even if the medication gets dialysed (sp?) out the amount of the drug that is metabolized before it leaves the system is enough to drop the patient's blood pressure. When it comes to IV antibiotics I will look them up just in case they might stay in their system. I hate when patients miss antibiotics...

[Orange Tree]

^ I agree, it totally depends on the situation, what procedure they are having, etc. Our cardiac surgery patients have a very clear protocol. With our vascular patients it varies, but usually they are okay if I give meds with sips of pills.

Dialysis nurses may correct me, but on my floor we NEVER give BP meds unless instructed before dialysis. Most patient's BP drops during/after dialysis. Even if the medication gets dialysed (sp?) out the amount of the drug that is metabolized before it leaves the system is enough to drop the patient's blood pressure. When it comes to IV antibiotics I will look them up just in case they might stay in their system. I hate when patients miss antibiotics...

Some patients get blood pressure meds before dialysis to keep their blood pressures from going too low.

[netglow, ASN, RN]

Before the OR the patient is usually NPO. If the docs want meds given, they will say "give meds with sip of water" Anticoagulats should be held before surgery, and the doc usually writes for it. Cardiac patients going for a simple procedure, or cath lab or open heart will have give cardiac meds with sips of water orders.

As for HD, hold the BP meds 2 hours before HD. If there are vitamins and supplements , they can be held until afterwards. It also depends on the time HD is scheduled. HD nurses are very knowledgable regarding this. Not all meds are dialyzed out....... It never hurts to ask.

Ask the MD. Shoud be pre op orders, and there will be post op orders.

[meandragonbrett]

There should be orders that clearly state one way or the other. We give all B/P meds with sips of water and PO Pepcid the morning of surgery. Everything else waits.

[anotherone, BSN, RN]

you can always ask the md. that is what i do for the most part.