IV Lopressor on the med/surg ward?

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Hi, I would like to know if anyone has been giving IV lopressor on the med/surg floor. Our surgeons have decided recently that the nurses on my unit need to give IV lopressor to post-op pt's. The pt's are to be put on tele and monitored by ICU nurses one floor below us. WE have to do VS q 5min x15min, then q15 min x30,then q 30min. The order is to give q 4hrs, so you are constantly in the pt's room. Our nurse pt ratio is 6-1, so this is very difficulty. I have been a nurse since 1981 and I have never been expected to do this on the ward.My experience has always been these pt's need to go to the ICU. And on top of this the pt was on an insulin drip as well, which in my experience that the pt's on insulin drip need to be in the ICU as well. Has the standards of practice changed??

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At my facility the Med-Surg nurses can give it for an NPO pt who is normally on it. They can't give it as part of the Lopressor protocol or if the pt has never been on it.

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Specializes in Med-Surg.

I've given IV Lopressor before, but not often.

That is an unfair expectation of a med-surg nurse. It's not fair to the other patients.

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lopressor IV push is pretty common on my med surg floor. It is always pushed slow and the vs are taken prior to administration and orders are generally do not give if SBP is less then 100 or HR is less than 70. Not a big deal here.

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Specializes in Cardiac.

IV lopressor somehow makes a pt ICU status???

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Specializes in cardiac med-surg.
The pt's are to be put on tele and monitored by ICU nurses one floor below us. WE have to do VS q 5min x15min, then q15 min x30,then q 30min. The order is to give q 4hrs, so you are constantly in the pt's room. Our nurse pt ratio is 6-1, so this is very difficulty.

who has time for that nonsense

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Specializes in Education, Acute, Med/Surg, Tele, etc.

Not our med surge floor since we do not have tele, and they have to be on tele for that per hospital protocol. We on the ortho med surge floor take care of cancer pts on chemo, and ortho surgeries and do not even have time for that along with the other things we have to sit in a room to do (chemo, transfusions, confused patient 1:1's when no CNA's are available, which lately there aren't).

These patients would have to go to the ICU, PCU for that where the ratio of pt to nurse is much smaller than 5-6 pts like mine (theirs is 2-3, which can be very high in that department as is!).

But we are a smaller hospital, and I think if MD's wanted to do this, they may need to get surgical privalage at another larger hospital with more rooms, staff, tele, and what not...

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Specializes in Pediatrics (Burn ICU, CVICU).
IV lopressor somehow makes a pt ICU status???

That's what I was wondering!!

We give Lopressor IV push very frequently...with pre and post VS. Dose held if SBP

I can't imagine an insulin gtt being reason for ICU status either.

I will add however, that our pt's are on monitors and our ratio is 3:1 for our floor pt's.

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Specializes in Neuro ICU, Neuro/Trauma stepdown.

i work step down (4-5:1), we give lopressor iv push. most pts are already on tele (esp if they are requiring prn lopressor). we also do insulin gtts, and heparin gtts, but only because they have protocol. we don't do any gtts that are titrated without protocol, but we start them and change rates with orders.

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Could you tell me where you work and what is your nurse pt ratio? Thanks. I work in SD at a VA.

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Our Med/Surg units don't give IV Lopressor - they go to the ICU. Not because Med/Surg nurses aren't qualified to handle it, but because their patient ratio doesn't not allow them to provide the close monitoring & frequent vitals that is needed - at least not without neglecting several other pts. They do have insulin gtts on Med/Surg units, however.

Requiring this on Med/Surg units is just part of the bigger pattern of increasing demands but not decreasing the ratio. I'm sure eventually it will be commonplace on MedSurg units. Today's MedSurg patients are yesterday's ICU pts. It's ridiculous. And that is why I don't do floor nursing anymore.

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Specializes in Mixed Level-1 ICU.

WE have to do VS q 5min x15min, then q15 min x30,then q 30min

Be sure to check your policy book. If you are not permitted to do this but are because the docs want you to, I would advise you to hang on tight to your license.

I don't know how you can follow those strict v.s. checks with all your other patients. Once you agree to do it, watch the accusations fly when, for instance, the bp drops too low because you were tied up with an emergency or any other task that requires more than 5 minutes to complete.

Does your nurse manager agree?

Mark

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