Legally how many doses can a nurse hold?

empatheticRN · Mar 23, 2015

If there are parameters then you can hold the medication. If there are none I'd notify the MD.

Donnagg123 · Mar 23, 2015

Even with parameters you can only hold so many days / doses then you have to notify md right?

RN403, BSN, RN · Mar 23, 2015

If you are holding a medication within the MD's parameters I would think that you would not have to notify the MD. If you are holding a med without parameters that is when I would call the MD a) to get an order and b) to let them know what my assessment findings were that led me to hold the med. The other nice thing about calling the MD when there are no parameters is that you can get parameters which will then prevent future calls.

Unless there is a problem (i.e, a pt with a fairly low BP that is symptomatic or with an excessively low BP) I would not notify the MD that I am holding a medication r/t parameters.

BrandonLPN, LPN · Mar 23, 2015

I don't believe there's a law for this situation. This would be more something that would fall into the category of facility policy.

mmc51264, BSN, MSN, RN · Mar 23, 2015

We have to notify every dose we hold. Other than SS insulin of course.

xoemmylouox, ASN, RN · Mar 23, 2015

I don't believe there's a law for this situation. This would more be something that would fall into the category of facility policy.

I agree.

BlueChocolateCat · Mar 23, 2015

I care for surgical patients and sometimes my patient's have scheduled opiates like tramadol or oxycodone. If I find that my 88 year old patient is simply too lethargic to get this dose, I'm going to hold the dose and document my RN assessment. I'm not necessarily going to page my on call at 3am to tell them I held a dose of tramadol... but I might run it by the appropriate LIP when they round.

Swellz · Mar 23, 2015

I always text the doc if I'm holding a med, unless it is insulin. Or the bowel regimen they never d/c'd on my patient with diarrhea lol.

BrandonLPN, LPN · Mar 23, 2015

In addition to following your employer's policy, there are situations where your nursing judgement comes into play.

There's always a reason a nurse might hold a med, and often those reasons are serious. In many cases where my judgement would tell me to withhold a dose, I would be calling the physician anyways to notify them of the change in condition that led me to hold the med in the first place. If I decided to hold a Lasix dose because the resident's BP is 68/32, I'd be calling to report the hypotension. If I held a narcotic because of a dramatic decrease in LOC, I'd better be on top of reporting that change. That I held medications in these instances is secondary info.

And the context of the patient's condition matters. If one of my LTC residents one day refuses to take their "water pill" because they don't want to pee a lot, that's not an asap, call-the-doc-right-away scenario. I can put in the sick call log, and the physician can address it the next day. But, if I'm caring for a hospital patient who's been admitted for CHF exacerbation and they refuse their Lasix dose, well, that's another story.

classicdame, MSN, EdD · Mar 23, 2015

I doubt seriously there is a magic number. Each med should be considered as a reason to notify the MD. He may have to change his treatment plan. For one thing, not to notify means the nurse is making a medical decision that not to give is "okay". Outside our scope

KelRN215, BSN, RN · Mar 23, 2015

Does anybody really think the legislature sat down and passed a law about how many doses of a medication a nurse can hold without notifying the MD? Can we please stop asking "is this legal?" for something that clearly has nothing to do with the law?

You use your judgment. If you're holding colace for a patient who's NPO or who hasn't advanced his diet yet, I don't see any reason why the MD would need to be notified. If your patient is on lisinopril with parameters to hold for SBP