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Discussion

Using judgement, med parameters

I am a new grad on orientation and I already know I am going to be posting on here a lot. My first question to those with more wisdom...

I had a patient who had IV BP medication ordered every 6 hrs for SBP > 160... It was NOT prn but was specifically ordered to only be given if it met BP parameters. The patient's BP was 158/90, so I did not give the medication. My preceptor was busy helping another nurse with a patient that was getting violent so she wasn't with me at that time. After she was done she told me she would have given it but she doesn't fault me for not giving it. She also said ideally I could have asked the doctor what to do about it but realistically most people would give it in the situation and most of the doctors would get annoyed if asked that. We re-checked the BP an hour later and it was really high, can't remember the exact numbers. So we wound up giving it... I just thought it was simple, didn't meet the parameters so it shouldn't be given I didn't think to question it... I'm wondering what others would have done in this situation...

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    I would have checked a manual BP to confirm and called the provider. On the opposite side, our new practice counsel recommendation is that when a nurse feels a med should be held (say BP meds) that do not have parameters, he/she must call the provider and have the med discontinued and reordered for the next day if indicated.

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    I personally would use both the parameters and the patients trends to make a decision. As a new grad use the parameters but recheck more frequently.

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    It is critically important to adhere to the physician's order.... many nurses have gotten into a peck of trouble by attempting to second-guess or assuming a degree of latitude that does not exist. If they physician gets crabby because they write a specific order which necessitates a call... then they need to modify the order.

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