Question about holding meds

makes needs known · Feb 5, 2010

Holding someone's medicine without a Dr's order is the same as prescribing medicine. Call the Dr. let him make the decision. Ask for parameters so that when a blood pressure is taken, you know when to hold it.

locolorenzo22, BSN, RN · Feb 5, 2010

It's true that it is being held due to a pressure of say 92/50....if that is not their norm. However, we have charting on our system for meds not given, and there is a spot for nursing judgement. I will personally hold bp meds for a little while and recheck on a later round, and give them if the bp has come back up. If asked why late, I chart clinical decision. you don't want them to bottom out and have it come back to you.

However, I do NOT feel that a bp of 120's over 70s warrent holding them...if you're that concerned, give em, and then recheck in like a hour or so.

ohgoodnessgracious · Feb 5, 2010

Nope, I would NOT have held someone's BP meds if they were at the 120s systolically. You're right, the meds are what's keeping her at that range, and so long as her HR was good, I'd have given it. I usually don't just hold a med until I get clearance from the MD - usually when the BP is below 110s or HR below 60, I'll call just to make sure (can't hurt to ask). Also it would depend on the patient, I think and how they're running. I've given BP meds to someone whose baseline was 90s SBP and she still received her metoprolols. Just make sure you do pre and post-med BPs!

HM2VikingRN, RN · Feb 5, 2010

I would have given it...I also make it a point to check a drug guide for meds I'm not familiar with.

NurseLoveJoy88, ASN, RN · Feb 5, 2010

You thought the right thing op. The meds should have given. If some htn meds are held it can cause htn urgency.

RedhairedNurse, BSN, RN · Feb 5, 2010

Hi everyone. Brand new nurse here, just started in med/surg (yay for a job!) and I am in orientation right now. I am with multiple preceptors, there are never any parameters for blood pressure meds, and each preceptor seems to have widely differing perspectives of when these meds should be held. One nurse had me hold all of a patient's bp meds when his bp was perfectly normal (~124/70-something), and then chart them as being held for a low blood pressure. Heart rate was normal as well. Her thinking was that she didn't want to give them and have the bp drop out of the normal range. My thinking is that the meds are what is keeping it normal and it should be given to keep it from jumping up. I really did not feel comfortable charting her reason for holding it either, as the bp was not low. Anyhow, I wasn't in any place to argue at the time as we were scrambling and, with me having graduated last spring and just now getting a job, I am not entirely confidant in my nursing judgment just yet. Oh, and no one ever seems to notify the doctors when any meds are held either. Is that normal? Any advice? The last thing I want to do is pick up bad habits...
Thanks in advance!

You were so right and the blood pressure meds should not have been held.

Maybe next time you can take something like this as an opportunity to teach your

preceptor and there is nothing wrong with that. For example, you could say.....I was

taught in school to hold only if the BP was less than 110/65 or 100/60. Or if heart

rate is less than 60 on metoprolol. It's okay to disagree with your preceptor, but very respectfully so. And if you don't feel comfortable charting something, don't do it. Just explain to her your reasons. You can also call the pharmacy or the doctor and they can often give you parameters to help give you info to back you up when disagreeing with your preceptor.

Also in regards to holding a medication, It really depends on the situation,

how strong is the med, how do her other pressures trend from previous checks.

And if this patient was going to surgery or something,

the nursing and physicians would have been ticked at the nurse who held this

blood pressure medication because so often pts can end

up with rebound hypertension after a surgical procedure and need that med.

And always you are to definitely notify the doctor when you hold a med. I know there are

nurses who don't, but you should. Its a CYA thing. Where I work, we have interns

on call at night so I'm not waking up the primary doctor, so I don't

have to worry about that. If I hold insulin, I call and get an order.

I will even get an order for changing out a foley.

Congrats on the new job, sounds like you're going to make a great nurse,

just hang in there. It gets much better after orientation is over and then

you are on your own and can make your own judgements/decisions. But

remember, there will always be somebody around to ask even after you're done

with orientation. Good luck and take care!

Sparrow23 · Feb 5, 2010

Didn't expect so many great responses! You all have wonderful advice which I will definitely be putting to good use. If this comes up again and the preceptor still tells me to hold them, I think I will tell her I'd feel more comfortable asking the doctor for some parameters and go from there. I am also going to check if we actually have any sort of policy on this...

Many thanks! :)

Bill E. Rubin · Feb 5, 2010

In actuality, I would think the answer would require more critical thinking. If a particular pt has been running a SBP in the 190s and for no apparent reason it's suddenly in the 120s and the order is for large doses of labetalol, hydralazine and Isordil, I would probably hold the meds and ask the MD. If the pt has been running SBP in a relatively normal range with a heart rate above 60 and was ordered for their 25mg of Lopressor or 10mg of lisinopril, I would just give the med as ordered.

If I held a med d/t hold parameters, I document it but don't necessarily tell the md unless specifically asked or unless it's clinically relevant. For example, holding Colace for loose stools, for most pts, is not clinically relevant (unless pt has a bowel obstruction or something like that).

RedhairedNurse, BSN, RN · Feb 5, 2010

Same with me as in the above post. If there are standing orders and/or parameters in place to hold a blood pressure medicine, then i will not notify the MD if I hold it. In fact, sometimes I'll call and get an order for blood pressure parameters if I ever have a patient that has an issue such as this.

I had a nurse I was training one night and told her to call to get an order, she said, "i thought that was nursing judgement." I told her it is nursing judgement but we still need orders to cover us.

Same with colace, if a patient has diarrhea, i would just inform the pt his/her right to refuse the med and in this case they usually will. So instead of saying I 'held' the medication, I will document that patient 'refused' rather than calling the doctor. It definitely requires using common sense.

If I hold a BP med because a pts BP is 120/70 and I don't call the doctor to get an order to cover me, then what happens if the pt suddenly spikes to 200/110 and strokes out. This is why I call, so that I will have an order to cover myself. Same with insulin, I will call to get an order if my nursing judgement tells me I shouldn't administer it, I want to have an order to back me up.....just in case.