the VA

[europeman]

why in god's name can we not write IV metoprolol in the VA for the nurses to give?

why?

someone please explain the ridiculous history to this. Post op patients often can't take PO for whatever reason, and patients on b-blockers i'm sending my intern to push IV metoprolol q 6 hours because the nurses can't do it unless in the unit!

Is this all VAs? Or just mine?


grr...

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[DO_Surgeon]

Just yours...as a CT fellow I give IV metoprolol like water in the VA. Sorry for your interns...

 

[ESU_MD]

Doesnt surprise me, outside of cardiac ICU, interns were still drawing blood themselves at the VA. VA was always bizarro world to me.... lots of resources, but a really eclectic mix of staff and wierd rules

I have heard of the metoprolol thing though, I remember when I was a med student I was constantly being sent to push the metoprolol IV on the floor! best bet is to just transfer the pt to the floor or give meds with sips

 

[butterfly0660]

At our VA, the nurses will always tell you the same thing. I spent many nights at the VA pushing metoprolol. Two solutions: 1. IV enalapril lasts longer, if that is an option for your patient. That bought me some sleep. 2. Although the nurses can't "push" metoprolol, they can (at least at my institution) hang it in a mini-bag. So they just add it to like 50mL of saline and run it in over 30 min or something.

 

[SouthernSurgeon]

We can't give metop IV to our patients at the University Hospital unless they are in a telemetry bed (or it's a critical situation like afib RVR and the resident is there at the bedside). So the VA experience doesn't seem out of the ordinary to me.

 

[europeman]

You can't give iv piggy back metoprolol?!

That's ridiculous.

Anyone know WHY va is like this though? It's a joke.

 

[Smurfette]

We had this stupid rule as well at our residency hospitals. Except the rule was the floor nurses could give IV metoprolol for rate control, but could not give it for hypertension. So we had to do it on all our NPO patients on the floor.

I did once have an ED patient code (brady'ed down to 10) because a nurse did a fast IV push instead of the slow push it is supposed to be. We got the patient back after a few minutes of ACLS, but it was a good lesson for the interns who would gripe about why it had to be a slow infusion....

 

[europeman]

There was something else wrong with that patient. It would have happened with an infusion too. Anesthesia pushes it like candy in and out of OR. Unless they were already Brady or blocked I can't imagine the fact it was pushed rather than infused was the etiology of your patients issue.

 

[Smurfette]

There was something else wrong with that patient. It would have happened with an infusion too. Anesthesia pushes it like candy in and out of OR. Unless they were already Brady or blocked I can't imagine the fact it was pushed rather than infused was the etiology of your patients issue.

Who knows? Obviously most people would not have such an extreme reaction. The cardiology and MICU teams said that's what it was, and she was on a monitor when it happened. There were no other obvious causes that we ever found. She'd had it IV before without having a problem tolerating it when she had been on the surgical service.

 

[Thanatos]

We had the same rule at our university hospital until just recently. My intern year we would joke that whoever was on call that night was "captain lopressor." Like most random nursing enforced hospital regulations, no one could really tell you why this rule was in place or for how long. Similar to above (I wonder if we work at the same place) nurses could push for rate control or if the patient was on a beta blocker preop. You would get a call to push the drug and the first thing you would do is look to see if they were tachycardic or on it preop then you could con the nurses into doing their jobs.

One of my more ambitious co-workers on call one night actually blew the dust off a cabinet where they keep all the chemical safety data sheets (anyone want to know the LD50 for hand soap???) and various training manuals from the 1970's and found some book that actually listed out all of these "rules." Turns out nursing could push IV metoprolol as long as the MD was present on the floor. They fought it like hell but my colleague, god bless him, took it all the way up the chain of command and got it done. In fact, after more careful review it turns out the nurses could push it if ANY MD was present on the floor.

From then on we would get the calls and tell the nurses to look out the door, and if there was a white coat sitting in the station they could push it themselves. One year later nurses are doing it routinely without complaint and our current interns don't actually believe this was ever a problem. Its actually my first one of those "back when i was an intern we had to study by candle light, walk uphill in the snow, sharpen hypodermic needles, and push metoprolol ourselves" kind of stories.

 

[filter07]

Interesting. I order prn hydralazine, metoprolol, and even dilt routinely on the floor as part of my post op orders. I do put in parameters though. I've suspected our nurses are pretty good and this thread makes me appreciate them more.

When I was an intern, the VA did have restrictions on IV blood pressure meds on the floor, but I think they've since relaxed those rules.

 

[Winged Scapula]

Like many of you, my residency (university) hospital had rules that patient had to be on Tele/ICU for nurses to give IV Metoprolol or Dilt. Many a night I also spent pushing that on the 4th floor.

 

[ESU_MD]

One of my more ambitious co-workers on call one night actually blew the dust off a cabinet where they keep all the chemical safety data sheets (anyone want to know the LD50 for hand soap???) and various training manuals from the 1970's and found some book that actually listed out all of these "rules." Turns out nursing could push IV metoprolol as long as the MD was present on the floor. They fought it like hell but my colleague, god bless him, took it all the way up the chain of command and got it done. In fact, after more careful review it turns out the nurses could push it if ANY MD was present on the floor.

I love stories like this. The vast majority of these nursing "rules" are BS, but its such a hassle to call them out on it.

 

[Buzz Me]

They'll usually pull the "but it's policy" line out.

 

[Dr.LeoSpaceman]

The "it's policy" excuse is generally code for "Doing that would create more work for us, so we made a decision not to do it." I've called a few Nursing Supervisors out on things that simply make no sense for why there would be a policy, and asked to see said policies in the hospital's practice guidelines. Generally I get stonewalled, but I have had a few victories. The biggest was proving that floor nurses were indeed allowed to change routine wound vacs.

 

[europeman]

Interesting discussion.

Anyone in particular have nurses hang IV piggy back metoprolol at their VA on non-tele patients???

Is there an actual hospital or nursing policy about this? AT THE VA?

thanks

 

[SouthernSurgeon]

Interesting discussion.

Anyone in particular have nurses hang IV piggy back metoprolol at their VA on non-tele patients???

Is there an actual hospital or nursing policy about this? AT THE VA?

thanks

n=2...at both the VAs I've worked at you cannot give IV metop on the floor; only in the ICU.

 

[deleted50541]

Interesting discussion.

Anyone in particular have nurses hang IV piggy back metoprolol at their VA on non-tele patients???

Is there an actual hospital or nursing policy about this? AT THE VA?

thanks

I did the metoprolol IV piggyback all the time at the VA on the floors. One of the few things I actually liked about the place. No where else could I get the nurses to do that, which drove me nuts after the 3rd or 4th time I had to push it myself. At that point, I'd usually put the patient in the unit anyway.