No BP taken before BP meds??

[brandinalove]

At my facility the process is to take a resident's BP prior to administration of their anti-hypertensives x 7 days when they're first admitted. If the 7 days show they have normal or high BP ranges then it goes to a weekly BP check and the nurses are no longer required to take their BP before administering scheduled BP meds. Just wondering if this is the policy at any other facility. The reason I can't comply with the policy is I'm convinced that the one time that I don't take someone's BP before medicating them that their BP will already be low and they'll bottom out.

[itsnowornever, BSN, RN]

I'd stick with your reasoning!!!! Elderly patients have slower kidney functions! What if there are still higher than expected levels of meds in their system? Are they citing any evidence based practice for having this policy?

[CapeCodMermaid, RN]

I think your policy is based in reality. 7 days is enough time to see how the resident reacts to the medication. We have some people whose bp has been checked twice a day for years because no one has the nerve to call the doctor.

People at home don't check their blood pressure before they take their meds.

[BrandonLPN, LPN]

7 days is more than enough time. These people are being given BP meds for long term management of a chronic condition. This isn't an acute care pt receiving IV Labetalol for a HTN crisis. I've been dishing a lot of pills to a lot of old people for a few years and I've never seen someone bottom out cause I didn't check their BP before giving them the lisinopril they've been getting forever. The routine, once a week (or whatever) VS are quite sufficient to monitor effectiveness after 7 days.

[BrandonLPN, LPN]

With that said, if you want to check every time it's your privilege as a licensed nurse to check vitals any time you think it's warranted per nursing judgement. No one can tell you: "You can't do that, policy is only 7 days". Tell them you can check a BP any darn time you please.

But I still say what you're proposing is unnecessary.

[kmarie724]

We don't take BP before administering BP meds except for when there is a recent med change or for a few residents who have a h/o their BP bottoming out. People at home don't take their BP before taking meds. And it just wouldn't be realistic for me to take the BP of of 15+ residents I am giving BP meds to.

[brandinalove]

Thanks for all the replies, I'm happy to hear this is the way it's done at most facilities and it does make sense to me now.

[zieglarf, LVN]

Our facility institued parameters (due to recent state inspection) to hold HTN meds if

[CapeCodMermaid, RN]

The state has no business trying to institute or influence clinical policies unless your practice falls out of accepted standards.

I would guess an overzealous DON thought that was a good thing for your POC.

[BrandonLPN, LPN]

Wow, parameters for EVERY BP med? Crazy. Staff inconvenience aside, this kills any chance for an even remotely home like environment.

[VANurse2010]

It's not necessary for chronic meds with chronic conditions. Exceptions apply with med changes etc. but a weekly BP is sufficient in most cases. These people are at home and don't need to be squeezed two plus times a day unless there's a good reason.

[flibbertygibbert]

I worked at a facility with a similar policy. It seemed to work appropriately. If we had residents who continued to have unstable BPs, we kept parameters and BP checks on those specific residents only, as the rest were stable and managing a long term condition. Again, you can always take a BP if you are unsure or if you feel a resident is displaying instability!