I am on a 22-bed unit. Six beds are stepdown. However, we have been administering Metoprolol piggyback to patients that are not monitored but in a general floor bed. These patients may have taken Metoprolol by mouth but now are NPO and still require the med, so the physicians have changed the med to IV piggyback every six hours.
Initially, we were told the patient must be in a stepdown monitored bed, but now we are told that if we take the HR and BP, we can hang the med as a piggyback on a patient that is in a nonmonitored bed. Pharmacy says there isn’t anything wrong with hanging the piggyback on the patient.
I think the patient should be on a monitored bed. Am I correct?
Nancy Brent replies:
Your question did not contain details about the patients who are receiving Metoprolol IV. Have they been admitted to the hospital after acute cardiac problems at home? Have they had surgery? Are they newly diagnosed with a cardiac condition? These, and other, factors may have an impact upon any clinical decision that relates to their care while on the unit.
However, generally speaking, most information reviewed about Metoprolol includes the caveat that when it is administered IV, the patient should be monitored carefully by EKG, BP readings and heart rate. And, remember that taking a drug orally is very different from having it infused. The patient may be quite tolerant of an oral medication. When it becomes infused, however, it is possible that a different result may occur.
It is important to note that your duty as a nurse is to protect the patient and ensure, insofar as possible, the patient’s safety. Also, standards of practice dictate how and under what circumstances IV medications must be administered. The fact that the pharmacist sees no problem hanging the Metroprolol does not equal that it is OK not to monitor the patient. The pharmacist is simply stating that there is no problem administering this medication IV.
You would be wise to check as many resources as you are able to concerning the monitoring of a patient with this medication IV. As examples, if you have an infusion nurse on the staff of the facility, he or she would be a good resource. If you have a clinical resource nurse/mentor, he or she would be another person with which to consult. Likewise, checking with your risk manager (who might be a nurse attorney or who is a nurse with a masters degree in health law) would also help.
Remember, though, that if there is a patient injury or death due to non-monitoring, it is the nurse who will be one of the defendants in any subsequent lawsuit. And, the standard of care for the nurse will be what other ordinary, prudent and reasonable nurses in the same or similiar situation would have done.