Nurses Didn't Call Doctor

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, MSN]

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]

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]

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]

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

[RNperdiem, RN]

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]

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, ASN, BSN, RN]

It is subacute rehab.

Staff is mostly agency nurses. 

[BC Roberts]

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