Withholding BP meds on a Dialysis PT

nosonew, BSN, RN · Mar 4, 2005

Ok people, I was turned into the state board by this group home manager (I'm agency) for not giving one of the residence his BP meds the morning of his dialysis. I was shocked when I got the notice from the state board regarding this. When I gave report to the morning LPN I told her what I had done. After talking with the state board regarding this, I was told I needed to contact the DR before I did this. I looked at the nurse investagator like she was from Mar;s// I told the investagator that if I called EVERY doctor on the morning of all my PT's dialysis I would get my butt chewed out.
They State board wants to get me for "out of scope of pratice" regarding this. I would LOVE to hear from all you Dialysis nurses out there regarding this. I am having one doctor and one dialysis nurse write a letter explaining what I did was not wrong.
I would love to hear from you all to help me boost my morale a bit..
Tony/PHX

Honestly it depends on the patient. There are some patients who have a renin response while on dialysis and their BP goes sky high. They have to have their bp meds. Other's go completely off their meds after starting dialysis and others take bp meds only on their days off or if their bp is out of a certain range. If you weren't familiar with the patient, I would have certainly at least called the dialysis center and asked them what to do or sent his medication with him to dialysis in case he did need it.

You are correct that most bp meds are held prior....likely in 90% of the cases I have. And there should have already been a doctors order from the nephrologist to hold it if the patient was having hypotensive episodes while on dialysis.

I don't think you should get in trouble for this one, as you were trying to help not hurt anyone. I hope it goes well for you! (Is there documentation in the chart regarding communication between the dialysis center and the facility you were working at?) Anything that spoke of low bp's etc? That may help you... good luck!

jnette, ASN, EMT-I · Mar 4, 2005

You are correct that most bp meds are held prior....likely in 90% of the cases I have. And there should have already been a doctors order from the nephrologist to hold it if the patient was having hypotensive episodes while on dialysis.

I agree with the above. :)

talaxandra · Mar 4, 2005

I agree with Jnette and notsonew - we routinely withhold antihypertensives on all out haemo patients the morning of dialysis, because you can always give them if they're needed but can't un-give them if the patient drops their bundle.

Did something happen to the patient?

RRN · Mar 4, 2005

I agree with Jnette and notsonew - we routinely withhold antihypertensives on all out haemo patients the morning of dialysis, because you can always give them if they're needed but can't un-give them if the patient drops their bundle.
Did something happen to the patient?

Some B/P meds dialyize out anyway so the are wasted.

What the OP did unfortunately was make a medical decision. A nurse can't just decide what meds to give or not give. You must have a doctor's order.

On the flip side you wouldn't give a med that was not ordered. You can't not give a med that is order. If you question whether that med should be given then you do just that call and get an order specific to when to give the med.

When we started getting a lot of dialysis patient at the local hospital I had to educate the ORTHO guys not to order MOM.. After I called them several times they got the message and went to something else...

Doctors need education just as much as nurses. Some nephorologist's just figure we know which ones to hold but that doesn't cut it..