RN Nick

I have a question with how your hospitals order their parameters for vasopressor/inotrope titration. This is because JACHO just went through our unit and cited us for something that, to me does not make sense. Currently, if we had a septic patient on a titratable medication, such asl Levophed, the order would look something like: Levophed 4mg/250ml NS. Start at 5mcg/min titrate for MAP >65. Notify MD if dose is greater than 20mcg/min. JACHO is telling us that unless there are specific titration intervals, ie: the order says Titrate by 2mcg/min Q5min we are overstepping our scope of practice as ICU nurses. Furthermore, If we titrate faster unless the order is changed. I don't under stand this. I was under the impression that the ability to titrate medications within a dose range to within parameters was under the ICU nurses scope of practice. Some patients end up being very sensitive to some of these medications and other require higher doses than expected. As we are weaning them off of these medications, their sensitivity often changes. Some of those patients that were crashing and on max multiple pressors/inotropes initially, become sensitive to that last bit of Levo as we wean them off. If we end up titrating based on patient response within the ordered dose range, we are now, under this JACHO rep's eyes, outside our scope of practice, unless we end up turning our Intensivist into a secretary taking him away from more pressing matters to constantly change the orders on how we are titrate.