PreAdmission Testing: who tells which home meds to take preop?

Specialties Ambulatory

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In the PAT department I am orienting in, there are vague guidelines on our printed brochure the patient gets that state the patient should be NPO after MN day of surgery, but take their heart or BP meds that morning with a small sip of water. The "understood" rule is if they are diuretics, you tell the patient to skip those. And if they are taking "stomach" medications, the "understood" rule is they take those, too. Other things, like pain meds, antipsychotics, etc are gray. I'm sorry, but I feel uncomfortable picking and choosing which medications the patient should take. I am afraid of the consequences of either taking OR omitting a medication. I can just see some surgeon or anesthesiologist coming back to me and saying "why the heck did you tell them to take/not take that drug?" My coworkers all have many decades of experience, so my 20 years makes me a novice. It all makes me feel like I'm practicing without a license and taking on too much responsibility with what I think should be the pt.s' personal physician's call. Am I making too much of a big deal about this issue?

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In the PAT department I am orienting in, there are vague guidelines on our printed brochure the patient gets that state the patient should be NPO after MN day of surgery, but take their heart or BP meds that morning with a small sip of water. The "understood" rule is if they are diuretics, you tell the patient to skip those. And if they are taking "stomach" medications, the "understood" rule is they take those, too. Other things, like pain meds, antipsychotics, etc are gray. I'm sorry, but I feel uncomfortable picking and choosing which medications the patient should take. I am afraid of the consequences of either taking OR omitting a medication. I can just see some surgeon or anesthesiologist coming back to me and saying "why the heck did you tell them to take/not take that drug?" My coworkers all have many decades of experience, so my 20 years makes me a novice. It all makes me feel like I'm practicing without a license and taking on too much responsibility with what I think should be the pt.s' personal physician's call. Am I making too much of a big deal about this issue?

I am a student in a nurse anesthesia program, and we also rotate through the preadmission area. We are responsible for telling patients what to take/not to take also, and I remember being very anxious over telling them the "right" or "wrong" thing to take. Basic guidelines we have:

-no ACE inhibitors the AM of surgery

-other antihypertensives are ok, especially beta blockers

-no insulin or oral hypoglycemics the AM of surgery, with half the dose taken the night before (if they take it at night)

-take all medications for reflux (prevacid, nexium, etc)

-no diuretics

-take synthroid

-take psych meds as scheduled, pain meds if needed

-stop all herbal medications 10-14 days prior to surgery

-aspirin and other blood thinners get tricky - depending on the type of surgery and type of anesthetic, the surgeons may want them to be continued (ASA is a big one...a lot of times vascular surgeons will continue them until surgery)....check your institutional policy on things like coumadin, plavix, etc. we routinely stop coumadin 5 days before, plavix 7-10 days before, ASA 10 days before as long as its not contraindicated.

(Keep i mind though, these are only guidelines for my institution, and may vary greatly from yours).

In all honesty, there are not that many drugs that will cause a case to be cancelled if the patient took them that morning. The big ones will be the blood thinners, possibly some antihypertensives, and the diabetic meds. The only time I had a case cancelled so far was for a patient who took her lovenox the morning of surgery for a total knee revision. You are right, without the proper education it is difficult to decide what a patient should take or should not take. We have a written protocol for what patients should take/not take, and if anythign deviates, we notify our staff to talk about it. Develop some guidelines with your coworkers - see what they tell people to take and what to hold.

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Specializes in Med/Surg, ER, L&D, ICU, OR, Educator.

We always told presurgicals to take all heart, BP, and asthma meds presurgically, but hold the others. Aspirin, Coumadin and Plavix were special cases and given specific instructions, as well as insulin and hyperglycemics in general.

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Specializes in Med/Surg, ER, L&D, ICU, OR, Educator.

I guess, more specific to the OP's question, that the ordering physician/nurse team is responsible for relaying this information.

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"In all honesty, there are not that many drugs that will cause a case to be cancelled if the patient took them that morning. The big ones will be the blood thinners, possibly some antihypertensives, and the diabetic meds."

Heart ICU and ceecel.dee: thank you for your response, the message seems to be it is indeed up to the nurse to choose the medications, based on institution guidelines. I am a L & D nurse "by trade", now in PAT, and most pregnant women that I am used to caring for are not on ANY medications, so I am having to look up most all the drugs to see what they are for and what their actions are. It would be nice, (like a very few of the primary doctors do), if THEY told their patients, when they met in the office to decide to do the surgery or procedure, what medications for them to take the morning of surgery, but I am hearing from you both that that is not reality. I guess over time I will learn the most popular drugs, look up the others, and it won't all seem so stressful. :uhoh3: Thanks.

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