Legally how many doses can a nurse hold?

[Donnagg123]

In a discussion today it was brought up about holding meds. A nurse said legally you can hold 3 doses without notifying MD. I thought you have to let MD know asap if you are going to hold meds? Legally how many doses can a nurse hold (if there are no parameters) before notifying MD?

[superT RN]

Simple...use your brain!

[JoseQuinones]

This is a case where you ask the doctor whether you can text their cell. Per my facility's policies, I fire off a text whenever I hold a dose. WhatsApp is perfect for that because all the nurses sharing the same patient are notified in advance of coming and checking the chart. So far no complaints, no problems.

If you use WhatsApp, be double, 100% sure not to share patient identifiable info.

[Angeljho, MSN, NP]

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

This.

Policies and laws can direct nursing practice but NOT nursing judgement.

[Simonesays, BSN, RN]

I agree with what the other posters have said. It depends on the drug that you are holding, why you are holding it, and what it is prescribed for. It also depends what type of unit you work in. I work in acute care on a med-surg unit. If I decide to hold anti-hypertensives for a patient whose BP is 102/66, I need to alert the team at some point about this action (on our floor we leave notes attached to the patient's chart). I will call the MD right away depending on the apparent etiology of the hypotension, if the patient is symptomatic, etc. There's no hard and fast rule about this within my health authority but you might have a different policy in place. Check with your unit educator if you're unsure. But most likely, you'll have to use your nursing judgment. If you're new, be cautious, however! Collaborate with a more experienced colleague whose judgment you trust to help you critically think through the situation. And if you are ever in doubt, I recommend erring on the side of caution.

[Donnagg123]

I did not mean to imply that you would never use nursing judgement to decide when to hold or not. I was just curious where she came up with the "3 dose" rule. If that was just a standard or some law I had never heard of. Of course if I held say colace because a resident was having diarrhea no I am not going to call an MD at NOC to tell him LOL But I agree with the others that if there is something in the vitals dramatic enough to warrant you holding meds like BP dropping etc then you need to get to the root cause...is there something more going on? I got the impression from the person that even still they felt it is okay to hold for 3 doses before notifying MD. Implying that I was overreacting. The person also believe that pretty much there is NO reason to call MD at NOC.

[madwife2002, BSN, RN]

Moved thread to Nursing and pt medications

[Nibbles1]

I believe it is per policy. One place i worked was 3. The place i am at now is 1. It is not a law.

[Donnagg123]

Thank you for that. :) She implied it was a law and she said "legally" and I was like ??? I did not think it was.

[icuRNmaggie, BSN, RN]

If the pt no longer tolerates or needs a particular medication, just ask to have it discontinued.

[nurseprnRN, BSN, RN]

Thank you for that. :) She implied it was a law and she said "legally" and I was like ??? I did not think it was.

Whenever somebody tells you something like this, ask them to show it to you in writing or on an official (e.g., governmental) website. Especially when they use the word "legal."

[Adele_Michal7, ASN, RN]

At my facility, 3 doses, and notify MD. Document lack of or presence of adverse reactions, reason for refusal/holding.

Nursing judgement comes into play here. If a patient is refusing scheduled Lovenox, and being adamant about it, I think the MD needs to know earlier than 3 doses (3 doses could be 1.5 days.)

Speaking of Lovenox, I frequently have my Asian patients refuse this medication.. I'm not sure why!