Nitroglycerin drips on telemetry units

Pill Hoarding Hussy · Mar 14, 2005

at my facility the "stable" tele floor (32 beds) and the step down (14 beds) both take pts on ntg, we titrate up and down as necessary to 200 mcg. our ratio is 1:4 24/7 on step down and up to 1:5-7 noc on the 32 bed floor. ntg alone is not a reason for icu, unless the pt is unstable/having a large mi. but the non-tele floors in my facility are not allowed to have ntg gtts. 1:4 or 1:5 sounds like a reasonable assignment fro ntg gtts, they just need continuous bp monitoring if you are titrating and watch out for hypotension after you give the cardiac meds...

nicholasmjb · Mar 14, 2005

The problem I have is the manner in which decisions of this type are made. In the vast majority of cases such changes reflect community standards rather than any evidence based practice or outcomes analysis. And community staffing practices are primarily reflective of budgetary as opposed to clinical considerations.
Individuals who do not have to practice under the conditions they decree over coffee and donuts give opinions as to what is safe as though their opinions carry the weight of evidence. So they make up arbitrary rules as they go along (If the patient requires 50 MCG of NTG they go to the Unit, if the patient requires more than 2 titrations during a shift they must transfer, if the patient requires upward titration they must be in the unit but if you are titrating downward they can stay etc etc.) The decisions are made in a vacuum without regard to the overall impact several such patients can have on an individual nurse's overall workload and the workload of the unit as a whole. In their world stable patients remain so....until of course, they crash and burn so obviously that they have to be rushed to the unit or they die.
Sadly, we have gradually bought into this management speak; we think we "know" the answers to questions such as this one, but do we really? If so, how would one explain the burnout rate of floor nurses, the large numbers of serious errors medication and otherwise, the failures to rescue, the recent outcry for emergency response teams, etc. Just a little food for thought if I may.

I agree with who is making these decisions. The real reason we are being encouraged to take Nitro drips is that CCU doesn't have enough beds. It worries me that patients are moved out of ICU's because they need the bed. The number of infiltrated IV"s is an issue now and monitoring BP's is difficult espesially when you can't find a BP cuff any where. It is also difficult because assignments aren't made by acuity but by bed order. Of course no one admits this but it is just easier for the charge nurse. The paper work is what keeps you busy. It seems we are triple charting for everything and it is the nurses responsibility to notify the doctor of labs and test results. Waiting on the phone to get ahold of a doctor takes up time. These patients also have other problems. Many with fractures and/ or confusion. Than the discharges take for ever. Back tracking and finding out what medications the patient is going home on is terrible. Why can't doctors write down exactly what the patient will go home on. Well I thing I just started another thread. Sorry.