Nurses Didn't Call Doctor

Updated | Posted
by Googlenurse Googlenurse, ASN, BSN, RN Member

Specializes in Home Health,Peds. Has 18 years experience.

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All weekend, a patient had a heart rate of 120 to 150. Patient who is 65 yr old  has an intensive history of tachy, dm, heart failure, severe obesity. Yet not one weekend  nurse called the doctor. Their reasoning was since his parameters on the monitor are low bp 70, high Bp 155, it was OK because it was within parameters. I noticed it was high, like 140 to 150 when I walked in. When he was sleeping it was 140 to 150. 

I did get some orders for lopressor and Coreg. Even then the patient still had high heart rates. Actually, the heart rate didn’t change  

Delia37

Delia37, MSN

Specializes in Critical Care. Has 15 years experience. 138 Posts

They absolutely dropped the ball in this case. In what type of setting do you work?? are you dealing with new nurses?? 

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. Has 30 years experience. 31,892 Posts

Let me make sure I'm understanding this correctly.  There were parameters of when to call in the BP and he stayed within the parameters of the BP so they didn't call in the tachycardia?  Makes no sense to me.  

I've been to many a case review of a patients who have gone south and over and over the question was "was the doctor aware", "did the nurse call the doctor".  

With tachycardia you sometimes have to dig deep to treat the cause.  Often, as in your case, medication doesn't help.  For example if it's anemia, sepsis, etc. a medication isn't going to help until you address the other causes.  Good for you for being the advocate and brining in the MD awareness.

klone, MSN, RN

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership. Has 16 years experience. 14,297 Posts

Are these new nurses? I cannot understand the rationale for not calling the MD because they didn't meet BP parameters. Do your orders not have parameters for other VS? Also, what type of facility is this where the MDs don't round on the patients daily?

CrunchRN, ADN, RN

Specializes in Clinical Research, Outpt Women's Health. Has 25 years experience. 4,435 Posts

Were there parameters for the HR in addition to the ones for the BP?

RNperdiem

RNperdiem, RN

Has 14 years experience. 4,544 Posts

Was this in a LTC setting? In an acute care setting, vitals are checked frequently and doctors round at least daily, and the heart rate would be noticed. 

Been there,done that, ASN, RN

Has 33 years experience. 6,881 Posts

What kind of facility are you in?  The heart rate needs to be less than 100. Sounds like a very complicated patient that needs a electrophysiologist to manage the rate.

Googlenurse

Googlenurse, ASN, BSN, RN

Specializes in Home Health,Peds. Has 18 years experience. 61 Posts

It is subacute rehab.

Staff is mostly agency nurses. 

BC Roberts

BC Roberts

9 Posts

My thought was dehydration, especially if on diuretic.  Good for you. Glad you addressed it with Provider.