Would you hold Metformin fot a BS level of 149

MunoRN, RN · Feb 14, 2014

I agree with you, Sam J. If I hold a med, I inform the doctor. I can certainly make nursing decisions and nursing judgment calls, but I would never withhold a prescribed medication without telling the doctor. My hospital strictly forbids this anyway. (If we do hold a med, we have to write a valid reason why it was held, who we told, and what the prescriber said when we called.)

As I pointed out, yes you need to inform the provider:

A nurse does not need a Doctor's order in any state to hold a medication. The Doctor should always be notified of your decision, but the final decision on whether or not to give a med is up to the Nurse. The Doctor is free to give it themselves if they can't convince the Nurse to give it. Determining the appropriateness of any medication when administering is within the scope of RN in every state.

Documenting the provider notification, your refusal and rationale are all universal components of what a Nurse contemplating holding a med needs to do under hospital policies, I hope you aren't confusing that with meaning that you are forbidden from refusing.

MunoRN, RN · Feb 14, 2014

No statement so broad can be taken seriously without at least a footnote, or a few hundred. And the word doctor is a common noun, not capitalized, as is the word 'nurse', that you at least also chose to capitalize on most occasions. That said, do LPNs also have the same, broad authority to hold meds, despite orders to the contrary? Please provide a source, either way.

Can an RN legally refuse to carry out a doctor's medication order for an opiate? | Nurse.com News

To be honest I'm a little disappointed in N.S. education if this is really something that needs a source.

NurseCollins799 · Feb 15, 2014

A nurse does not need a Doctor's order in any state to hold a medication. The Doctor should always be notified of your decision, but the final decision on whether or not to give a med is up to the Nurse. The Doctor is free to give it themselves if they can't convince the Nurse to give it. Determining the appropriateness of any medication when administering is within the scope of RN in every state.

Agree, although if a nurse refused to give metformin because they thought 149 was too low, they better have really solid evidence and be able to articulate this to the team, because on face value this is stupid medicine/nursing. I've never met a patient who gets symptomatic >120

ParisAntonel · Feb 22, 2014

I wouldn't hold metformin for a BG of 149. If the pt is NPO ( no TPN or TF) for a procedure , or did not eat lunch , or was hypoglycemic and you had to give D50 , and now BG is high, I would hold metformin, insulin if BG 149 or even higher than that and notify MD.

Yosemite, RN, ASN, EMT-I · Feb 28, 2014

Metformin is less likely to cause hypoglycemia than other oral agents. More likely to cause lactic acidosis. I believe the important point in this discussion is: What are the physician ordered parameters? Call the physician, IT'S WHAT THEY'RE PAID FOR. Have the M.D. make the decision. If she/he is upset over the call, consult your nurse manager and remind him/her that the M.D. should have set parameters in the ORDERS.

Nola009 · Mar 3, 2014

Me-oh-my...

Now some newly hired nurse whose been practicing longer than told me in report that she would have held scheduled Lantus for a BS of 152. Come on. It's a long acting and yeah, she supposedly 'bottoms out' when sliding-sclae coverage is given sometimes (prolly bc the aides don't encourage and report when she doesn't eat her meals). Everybody else just goes with it, though.

I didn't give Novolog. I gave Lantus. I think the point is that we wanna get her BS well-managed enough so that we might not need the sliding scale insulin all that much. This place--- it makes me nervous. Too many supposedly "bright ideas" that aren't so bright.

Starting to feel like I work at a really dysfunctional place!

kanzi monkey · Mar 8, 2014

It does sound a bit dysfunctional. Listen to your instincts, ask questions, and maybe keep looking for a new position. Sounds like your co-workers need some refreshers on diabetes medications.

Also, in response to the comment above, it is NOT a physician's job to teach nurses basic pharmacology.

strength4unityRN · Mar 8, 2014

I personally wouldn't hold it. Do you know why your supervisor requested you hold it? Does the patient have a diet ordered? Are they NPO for a procedure? Have they been having problems with hypoglycemia?

Whoatemyburger · Mar 8, 2014

Metformin alone normally doesn't cause hypoglycemia . If used with other anti-glycemic agents , it may . I had to call the Dr. Yesterday because my patient BS was 105- he was supposed to get 17 units humalog pre meal and 2 units additionally .. Plus 35 of NPH. Even when his sugar was 150, I called the same Dr. Just to verify . As a fairly new nurse my self , my advice is to always ask questions. Call the doctor if you have to. Protect patient safety and also your license !!!!!

BrnEyedGirl, BSN, MSN, RN, APRN · Mar 9, 2014

Unless there is more to this story,...I wouldn't have held it,....I wouldn't have even asked my supervisor. If my supervisor insisted I would have charted "held per Nurse Nancy floor supervisor".

Nola009 · May 14, 2014

Now there's TWO LPNS who hold lantus if the BS is around 150. They claim it is their right to do so per 'nursing judgement'. Mgmt doesn't do anything about it to my knowledge...?

Nola009 · May 14, 2014

Unless there is more to this story,...I wouldn't have held it,....I wouldn't have even asked my supervisor. If my supervisor insisted I would have charted "held per Nurse Nancy floor supervisor".

I didn't ask her. She.was right there orienting me to a new area and told me to hold it. Whatever, boss.