Coreg med and no heart rate parameters?

Nurses Safety

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I just started as a nurse on a medical floor, I was on orientation. I had a coreg to give and the heart rate was 52, there was no parameters entered by the physician so I went ahead and gave it. Unknown to me, my preceptor came up to me later and said I wasn't suppose to give that because his heart rate was too low. No one told me on the floor that 60 was their magical number that was too low to give for coreg. (I still have to look up their policy and procedure) I was taught in nursing school that if its below 50 the general rule is to hold it if there is no parameter on it. I looked it up in my Davids drug book and it says the same thing, to hold it if its under 50. Consequently I was fired this past Monday due to this error. What is everyone's thoughts?

I'm so sorry this happened to you. Go forward now, I wouldn't put on resume though.

It's a lesson learned in

Somehow it didn't finish. Whenever you come across these meds again, from the beginning ask when to hold or give this medication. The hospitalists always give those orders, as far as the cardiologists it's like pulling teeth with them but its our license we have to protect.

Specializes in Med Surg.
What was the error here. There were no parameters given for the med. One could argue that you should have made a call to the doc. That's about the only issue you could have here.

FWIW, I have seen situations where pt's are beta blocked into the 40s and parameter for the dose is "hold for HR

Ok, but. If someone is precepting, isn't it always better to CYA? If HR

I guess I'm always thinking, worst case scenario, I want to have brought this up with someone. I mean, I'm in clinicals now, but I see something wonky and I report it off and document that I reported it, to whom, etc. I mean, what do I know, experience wise, compared to someone who's been there for years? So maybe I'm the world's worst PITA, but why wouldn't you ASK.

Specializes in Med Surg.

The other thing - I agree with a couple of other posters who asked if there was any other reason they might have wanted to terminate you, personality clash, anything? I think its true of all employment (not just nursing) that people get told the real reason they were fired about as often as they're told the real reason they weren't hired. That is, not very often.

True, more persons are fired for not getting along with the wrong person than for poor performance.

The other thing - I agree with a couple of other posters who asked if there was any other reason they might have wanted to terminate you, personality clash, anything? I think its true of all employment (not just nursing) that people get told the real reason they were fired about as often as they're told the real reason they weren't hired. That is, not very often.
Specializes in Emergency, Telemetry, Transplant.
Ok, but. If someone is precepting, isn't it always better to CYA?

I agree that you should CYA and the person you should talk to is the doc. However, unless there is a written policy for the unit/facility, then a HR of 60 is not a definitive cut off Coreg (or any other med). If it is given despite a "lowish" HR (e.g. 55) and the pt has an episode of symptomatic bradycardia, then, well, there will be an issue if the nurse did not cover his/her rear by calling the doc before giving the med. Otherwise, there should no be any problems giving the med even with the stated HR--in other words, if the pt tolerated the med just fine, why punish the nurse for giving the med without calling the doc?

Iam sorry this happen too you. Its hard to believe that you were fired for just one incident. The magical number 60 comes from what is a normal heart rate anything less then 60 is considered Bradycardia.

That's kind of harsh; personally I always hold the medication if its less than 60. But I agree that parameters should have been given to give or not to give

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