I have an friend who went to the ER in the hospital where I work. She had a terrible headache and a BP of 206/110. Labs where drawn. A CTA cardiac was done, EKG, etc...I saw her today and asked her how she was doing? She still has high BP, she still has headaches, she looked very uncomfortable. I said didn't you get a script for a BP med? "No, the tests were all normal and the ER doctor was uncomfortable starting me on a BP med because I don't have a PCP and I made an appointment with a doctor and can't get in until the 20th".
Is this because in case the BP med caused an allergic or adverse reaction she wouldn't have an available doc?
Or do you think she should have gotten a script for her BP and told to check her BP daily until she gets an appt and if there is any further trouble before the doctors appt to come back to the ER?
I am basically appalled that she went to the ER for significant hypertension and was not treated for it. She was told her headaches were causing the hypertension. I think it's the other way around and besides no matter what, hypertension like that needs to be treated. The only thing they gave her in the ER was a pain med for the headache. :uhoh21:
In my humble oppinion you should be more apalled at your friend for not maintaining her own health by seeking regular medical care, such as a routine physical. The ER is not the place for treatment of a CHRONIC medical problem to start and chances are another 3 weeks or so of HTN isn't going to do much more damage than what has already been done.
So no, this is not medical malpractice.
Swtooth EMT-P, RN
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Where was it mentioned that she does not maintain her own health by seeking regular medical care???? She went to the ER for a severe headache not relieved by motrin, a person at her office had a wrist BP
apparatus and checked her BP. This was the first time she ever realized she had high BP. It was after 5 pm. Don't read things into it that aren't there. Thanks.
Hopefully your friend can get into a PCP sooner than the original appointment!
Until her appointment though, does your friend have any way to regularly monitor her BP? Around where I live, EMS services and Fire Dept. will check BP's at no cost. A log of BP's might assist the doctor when considering any treatments; along with a brief note of any symptoms, activity just prior to the BP check, or any significant stressors around the time of the BP.
On a personal note, I had an experience a couple of years ago with suddenly elevated BP 170/120, along with a headache and chest pain. I too was very frustrated with the ER doc not giving me a BP med. Well, I was having problems with my asthma and had just finished a course of steroids. I wasn't taking walks like I usually did and was dealing with cravings (salty and sweets) from the steroids. When I got in to my PCP for followup a couple of weeks later, my BP was much lower. I was taking walks and the steroids were getting out of my system.
My PCP told me if I had been given a BP med, we could have been dealing with hypotension at this point. She also pointed out that since I was usually healthy and my cardiac labs/ ekg etc were normal that the doc had also figured that my body could take a short time of hypertension and that a decision of BP meds needed to be made by my PCP who knew of my whole health history, not just a few minutes in an ER.
Yes she did and I blame the lack of concern on the over availability of medical assistants. :angryfire vs the more knowledgeable, yet higher priced, licensed nurse.
Has she tried asking the medical assistant to have a nurse return her call when available? I've done this before and sometimes a nurse can advocate to get her a quicker appointment or call if there is a cancellation.
Has she tried asking the medical assistant to have a nurse return her call when available? I've done this before and sometimes a nurse can advocate to get her a quicker appointment or call if there is a cancellation.
Where I live doctors offices do not employ licensed nurses because medical assistants are so much cheaper and they don't seem to have a problem with it. Medical assistants are very capable within the limitations that they are taught, however, many (not all) way overstep those limitations and refer to themselves as the "nurse". It's a really sore subject with me.:angryfire Can you tell!?
Yes, she does have someone to monitor her BP (now). I talked with her tonight, I told her I know the PCP very well and will talk to him about getting her in sooner.
i do agree .she received appropriate tx in ed .for chronic problems if it turns out to remain high then pcp needs to order the med .she was told to f/u it is her responsibility to do so .most times if she called office stated she was seen in ed and asked to f/u in 'x' number of days they would fit her in.
As to malpractice or not, I cannot say. It depends on many other factors. But for one, you would have to prove harm. And there does not appear to be "harm", here. If the ER stabilized any immediately lifethreatening issues and referred the pt to appropriate treatment, then their job was probably done.
The ER is not the proper place to start regulating hypertension. Nor is it a good idea to start a BP med regimen on a patient based on a one time ER visit. The issue could be a transient one, or it could be long term. It may be caused by many different factors and causes, all of which need to be assessed by the patient's PCP. And if the patient does not have a PCP, they need to take the initiative to acquire one, that can followup appropriately.
While allergy attacks are a possibility, starting a BP med regimen requires that someone take the responsibility for monitoring side effects, resulting BP and followup. That is the responsibility of a primary care practitioner, not of the ER department. Once the ER has established that the patient is not emergently going to die, and that the patient does not meet criteria for admission, their job is done. And while patients are sometimes admitted to regulate blood pressure, this generally occurs after much outpatient treatment, and determination that it requires an admission to inpatient care, and or when the PCP determines that is necessary for safety reason.
In fact it could be malpractice if the ER willynilly prescribes a BP med based on one visit. If the patient has certain conditions, it could plummet their BP unduly, causing them to faint and be injured, get into accidents and harm others. Or affect heart function. Or if they find the side effects undesirable, may go off the meds abruptly. Thus healthcare oversight is paramount, which is not the ER's job but the job of the PCP.
The other issue is if a patient is not cognizant enough to maintain a relationship with a PCP, how compliant are they going to be w/ checking BP daily. Some people will agree to anything to get their pills, and then put off seeing or visiting the PCP, because they feel better or they "don't have the time". If they have to see the PCP for treatment, they will do it quicker than if they have something "to tide them over". ERs are aware of this behavior issue with human nature.
I'm not sure if "cognizant" is the issue. Maybe you were thinking "responsible". The real issue might be money, maybe this person has never been sick before and never really needed to maintain a relationship with a PCP. Maybe her insurance changed and she has to chance docs and hasn't had time to do that yet.
I'm also not sure how the ER doc knew the patient wouldn't die.
I'm also disturbed that this pt has to wait for 3 weeks to get seen for a very high BP. What are people in this predicament supposed to do? She might need to go back to the ER in the interim, too.
Specializes in Adult and Pediatric Vascular Access, Paramedic.
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Where was it mentioned that she does not maintain her own health by seeking regular medical care???? She went to the ER for a severe headache not relieved by motrin, a person at her office had a wrist BP
apparatus and checked her BP. This was the first time she ever realized she had high BP. It was after 5 pm. Don't read things into it that aren't there. Thanks.
You did clearly state in your original post that she has no PCP... That tells me that she does not see a regular doctor, especially since it seems this HTN wasn't discovered until she was symptomatic, so it was probably ongoing long before this incident.
You did clearly state in your original post that she has no PCP... That tells me that she does not see a regular doctor, especially since it seems this HTN wasn't discovered until she was symptomatic, so it was probably ongoing long before this incident.
Swtooth EMT-P, RN
According to Dutchgirl, the friend had no PCP in the area because she had just moved there a few weeks before.
Its probably what I would have seen in any ER i have worked in the last 20 yrs. About the only time I have ever seen an ED doc write a script for BP meds is after speaking to a PCP or on the rare instance the pt actually has an empty recent- read that just ran out bottle for meds.
I can count on one hand the time they have in other instances when neither of the above applied and they have. But then even in those cases the pts had confirmable follow up.
My mother, a coffee addict, was visiting a friend of ours in the hospt. with me. her face was all red and she had a headache. I took her bp 197/102. EEEKKKK mom, what is going on!!!
well as it turns out, the power had been out at their house for days and when it finally came on, about 1.5 hours ago. she made and drank an entire pot of coffee. (tisk tisk.) :nono:any way i made her go to her pcp asap (turned out to be 3 days later) and her bp was normal. But had she gone to the ER in that state and they had started her on anti-htn meds, she could have gone hypotensive and crashed once all that caffeen was out of her system.
so you see, htn is really something to be followed, not treated off the cuff, after only one er visit.
But had she gone to the ER in that state and they had started her on anti-htn meds, she could have gone hypotensive and crashed once all that caffeen was out of her system.
so you see, htn is really something to be followed, not treated off the cuff, after only one er visit. hope this changes your perspective
Yes, I'm glad I brought this up. Several excellent posts, such as yours point out very good reasons not to give scripts for BP meds in the ER.
The standard of care was followed. Therefore, malpractice is not at issue. It doesn't sound like hypertensive urgency or crisis (which would be treated by the ED). It's an emergency room. We aren't responsible for following a chronic problem like hypertension. Your friend got the "million dollar workup". She did not have an emergency. She needs to follow up with a family practice or internal medicine doctor. We once had a patient write letter of complaint. He had presented to triage with a non urgent complaint and was angry about having to wait a long time to be seen by a doctor. I remember the last line of the letter. "Do you people wait until an emergency actually occurs before you do something?" Yeh, that's pretty much what we do. (Actually, we take care of everyone who comes through the door. We just see those with emergencies first.)
DutchgirlRN, ASN, RN
3,932 Posts
Where was it mentioned that she does not maintain her own health by seeking regular medical care???? She went to the ER for a severe headache not relieved by motrin, a person at her office had a wrist BP
apparatus and checked her BP. This was the first time she ever realized she had high BP. It was after 5 pm. Don't read things into it that aren't there. Thanks.