IV Push Lopressor on a Med-Surg Unit??

[LuvMedSurgNsg]

Can anyone give me some input on this one? Some of our surgery guys want us to administer IV Lopressor (metoprolol) to their pre/post-op patients who are on routine PO doses but can't take it due to NPO status. Current hospital policy say no IVP lopressor w/o a continuous cardiac monitor. The docs argue that the drug is safe in IV appropriate doses w/o a monitor as the pt takes and tolerates the drug on a daily basis. We would not start a pt on the drug IV w/o a monitor...only provide maintenance doses in a pt already tolerating the drug. I brought this to the nursing policy review committee on behalf of the docs and, as my punishment, I inhereted the project. So.....I'm surveying the community for their practices. Please advise! Thanks!

[meownsmile, BSN, RN]

Well first i have to admit i dont know what our exact policy is for this in med/surg. However, i dont think id be comfortable doing it. Why is it they cant give the med in holding when they are being monitored more closely if they feel they need it. When we have a patient that is on B/P meds they will usually have us give them with sips of H20 at least 3 hours prior to surgery if necessary.

[rreed]

I don't know what our policy is, but we give it all the time on a med surg floor.

[Going80INA55]

NO. Our policy is NO monitor NO IV Lopressor.

I would be very concerned giving it on a very busy med/surg floor with out the benefit of a monitor to see what happened to their pulse rate.

Had a situation once where a woman had an order for IV lopressor and she was on med/surg.....we had no bed on step down to take her....so I shlepped up stairs with a portable monitor, hooked her up and gave the med.

[Rapheal]

We do it with patient on a monitor.

[CANRN, MSN, RN]

We have monitors on the patients on our med/surg floor who get IV Lopressor, Lanoxin, etc.

[litebrite]

We do not have monitors. We are able to give it IV if it is a routine med. So not a one time dose. They would have to get it once a day or more. I think I have only given it a few times over the past few years.

[Glad2behere]

Our policy is not a strict NPO policy. All meds given PO remain PO with a sip of H2O preop. I work CCU, and rarely have I given Metoprolol IV. I gave it twice last week PO as the anesthesiologist was doing his preop assessment as we were moving the bed to OR. The second time I asked why he preferred to give it PO like that on the way to surgery. His response was to not change a thing the patient had already been doing, and preferred the the current patient baseline status.

[moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS]

NO, no, no. No IV push Cardiac med unless:

1: Your unit is able to do cardiac monitoring

2: You feel comfortable in knowing cardiac rhythms and interpreting what is happening.

3. Must also have BP monitoring.

This is why our floor a general but cardiac specific floor gets all the surgicals until they switch to PO. Our Med Surg nurses are not cardiac trained.

[PerkyCardiacRN]

Originally posted by moonshadeau

NO, no, no. No IV push Cardiac med unless:

1: Your unit is able to do cardiac monitoring

2: You feel comfortable in knowing cardiac rhythms and interpreting what is happening.

3. Must also have BP monitoring.

This is why our floor a general but cardiac specific floor gets all the surgicals until they switch to PO. Our Med Surg nurses are not cardiac trained.

This is the exact way the facility is where I work.

[FullMoonMadness]

Routine or not,I wouldnt do it w/o a monitor. All of our pts. with IV cardiac meds are on a monitor,we let the tech know when the push is started,how much and when it ends,so that the push can have a monitor strip to corelate it.

[kewlnurse]

Absolutly has to e on a moniter, I wouldn't even give it, seen a pt. go asystole 5 minutes after getting it.