Taking daily pulse with digoxin - Need help with IDR

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Specializes in LTC, Hospice, Case Management.

Looking for some help with my state survey POC. We got only 1 nursing tag (yea us) and of course I'm rolling up my sleeves and planning to IDR this and I believe I have a reasonable chance. We're a small facility and had 2 med pass errors which put us just over the threshold for greater than 5% med error rate (F759). One of these "errors" was not taking a pulse prior to giving Digoxin. There was no physician order to monitor pulse, we take pulse weekly with other vitals and pulse always stable, our policy said "take vitals as necessary....". The surveyor cited based on Nursing 2013 drug handbook that indicated administration includes taking a pulse prior.

In long term care, this is outdated practice from everything I've heard & most facilities I've been a part of has gone away from all this over monitoring years ago to reduce nursing time during medication pass. We all know patients in their own homes do not take daily pulse with digoxin, blood pressures prior to HTN meds, etc. Problem is - I'm having a lot of difficulty finding credible resources to support my IDR efforts. Anyone with a good resource to support this practice?

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Specializes in Gerontology, Med surg, Home Health.

I'm not sure I can site a credible source but....

Taking a pulse for digoxin went the way of the boom box. If there is no parameter ordered, we don't take a pulse. I've spoken to many cardiologists and medical directors and they all agree this is old practice. If I were you, I'd call the pharmacy consultant and get his/her input.

Congrats on your great survey.

Let us know how you make out.

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Specializes in LTC, Hospice, Case Management.

Thanks. I found a great article from the American Journal of Medicine in 2015 on Digoxin. This article stated that the dosage should not be changed based on heart rate alone. My pharmacy consultant also provided me with documentation from one of his sources that stated that a baseline heart rate should be established and then monitored periodically (which happens with our weekly vitals and hers were all in place). I also had the attending, who is also our Medical Director, write a letter to support that there was no need for a daily pulse on any resident taking Digoxin unless ordered by MD. I sent my IDR statement and documents in yesterday. Unfortunately it will take up to 60 days in Indiana before we get a response back.

My competitive spirit wants to win this one bad, but in the big picture, I'm just grateful for an awesome survey.

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Specializes in Gerontology, Med surg, Home Health.

In Massachusetts we have to hand deliver our IDR things to the DPH at a grand meeting.

Good luck.

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