IV Lopressor...who can administer it?

Aneroo, LPN · Mar 13, 2009

If you're not trained to do the cardiac monitoring required to give that medication, I would not give it.

I do not believe you have to be ACLS certified to give it, but you do need to be able to note something abnormal and intervene.

Is the emergency drug guide the one that comes with ACLS training, or is it specific written MD orders signed by a doctor in your facility? If it's just the training book/pocket book from ACLS, I'd say no.

patwil73 · Mar 13, 2009

The nurse doesn't have to be ACLS certified (at least at my facility) but either they or someone should know how to read the telemetry when giving the med. At our facility they are supposed to call the tele tech and let them know they are pushing lopressor so the tech can watch for any drop in HR.

Hope this helps

Pat

hypocaffeinemia, BSN, RN · Mar 13, 2009

While beta blockers can sometimes exacerbate or even initiate an AV block, there really isn't anything significant from a telemetry standpoint that needs to be monitored. A telemetry unit isn't necessary to determine bradycardia and hypotension if you closely monitor your patient. Have you considered having a dynamap with SpO2 sensor at bedside for 30 minutes or so?

sonja77 · Mar 13, 2009

i also work on a med-surg floor and per policy the only two cardiac meds that we can give ivp are lopressor and vasotec. then we have a policy about what meds an lvn can give per ivp and only vasotec falls into that category. lopressor has to be given by an rn. it doesn't matter if the rn/lvn is acls certified or not.

and we can give lopressor up to 5mg without telemetry monitoring, for any dose greater than 5mg the pt has be be on telemetry.

CraigB-RN, MSN, RN · Mar 13, 2009

Unfortunatly this isnt' an easy question to address, because there are to many "it depends" It depens on your state practice act and your local policies.

As to being ACLS, to the best of my knowledge there is no Law or practice act that says you have to be ACLS certified to do anything in nursing. It's all addressed in the nurse practice act and the local policy.

Why do you think that as a non acls LPN you can't give the med, Were did you get that idea? You might have to be creative in finding a policy to cover it. First get a copy of your states nurse practice act and read it an know it inside and out. Then hunt for the policy or one that address it. You might need to ask the hosp pharamcy or other area's outside yours. There should be a hospital wide medication administration policy. If you still cant find one, volunteer to work with your clnical educator to develop a training program on how to administer teh drug, and a competency for it. Makes you look like your being part of the solution, and it helps protect you from liability and such.

I've worked in so many states that i can't keep them straight. I even worked in an ICU that had LPN and it was fun, because they couldn't administer certain meds and I've worked in places were LPN can give no IVP meds. That is one of our problems in nursing, the answer is all to often, it depends.

lpnflorida · Mar 13, 2009

First off, what state are you working in. It would be much easier to answer the question. In florida, yes we can administer lopressor iv as an LPN if you are on a unit which has tele. It might also boil down to what your particular hospital allows. We do not admininster it in rehab as we have no tele beds. However when I have worked on the acute side of the hospital yes, have done it..

Ruffles 1 · Mar 13, 2009

In our state of Missouri, LPN's are not allowed to give any IVP meds. I would also think that the patient would need to be on telemetry to monitor HR and BP, Ox Sat. etc.

rjflyn, ASN, RN · Mar 13, 2009

To add to the others 1) does your nurse practice act allow LPN's to give IV meds 2) I personally will not give it unless the pt is on a monitor, not just tele, but one I can see as I give it- that just me have had one too many times of pts HR going the crapper by not being able to see it.

denise.programchair · Mar 13, 2009

Hello,

the question you pose is a good one and the answer requires knowledge as to what is in your scope of practice. According to the NCSBN, it is not typically in the scope of practice for LPNs to administer IV meds. Consider how many questions you see on the NCLEX-PN exam. Take a look at the detailed test plan for the NCLEX-PN. Ask yourself as to whether or not you see many or even any references to IV meds and LPNs. You won't find many if any.

The most specific guide is your state nurse practice act. Whereas you may not find a detailed list of duties, you will find wordage to the effect of "tasks most commonly performed by an LPN". That means what's usual in your state. If this is not the usual practice and your facility requests you to do this and an untoward event occurs, the first question posed will be is this the usual practice. If not, what criteria caused your facility to detour from what is usual. What is best practice? And, what does the procedure manual for the facility say?

The other concern is knowledge. What is the knowledge base and prep for this type procedure? I was program chair at a practical nursing program for five years and in most practical nursing programs, this type of knowledge is not provided nor expected. These are specialty drugs that require knowledge that is typically deeper than that provided in practical nursing programs.

The other question to pose is this: What does it say in the procedure manual? Whom does it say may perform procedures such as this? What is best practice? And, what does your facility have in writing regarding protection for you should litigation occur. I ask because if you do a procedure that is outside your scope of practice and nothing is in writing regarding your protection, the supervisor will probably say you misunderstood the instructions or whatever. You may find yourself on the wrong end of a litigation suit where your needs and the facility's needs are at odds.

Just something to think about!

Denise

Trophywife81 · Mar 13, 2009

I worked as an LVN in Texas, where LVNs have a quite wide scope of practice; the hospital for which I worked employed TONS of LVNs. On the telemetry floor I worked, I routinely gave 5, 10, even a few times 20 mg of IVP Lopressor. Per hospital protocol, all pts on Lopressor were scheduled for Q4 vitals, and I frequently checked HR even more often and ALWAYS before giving the drug. I'm sure I'll shortly hear of all kinds of contradictory stories, but in my experience, 5 mg of Lopressor was virtually useless in treating tachycardia...the pt. was doing good for their heart rate to drop 3-4 bpm.

txspadequeenRN, BSN, RN · Mar 13, 2009

i am a texas lvn as mentioned above we have a wide scope of practice....i have pushed many drugs but stay clear of cardiac drugs whether i can give them or not ..there are much more willing people to do so...i guess i should get used to it though since i will be a rn very soon....awaiting nclex -rn wooohooo my thought is if you are pushing the cardiac drugs you need to have that patient monitored...