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I work on a medical floor at an acute care hospital. We have an outside acute care dialysis unit on site. Since they are an outside vendor, they have no access to our medications or records. Cardiovascular medications are scheduled for 6am. These are started at 5-530am and hopefully finished by 630-645. We usually receive a preliminary list of pts going for hd the night before. The first patient leaves the floor at 7-715. The timing varies due to acuity, admissions etc. However we often do not find out until after cardiovascular medications are given. We have no written guidelines and it is based on nursing judgement on whether to hold meds or give them. We are a teaching hospital and it is very difficult to change policy and behavior. However, I am trying to initiate guidelines. We do not even have a chart for which meds are dialyzed out. We have had patients unable to receive adequate dialysis due to high and low bps, episodes of svts and even one patient that had a seizure; All of which may be related to medication related problems. I feel that it is beyond our scope of practice. Community practice is not adequate to protect my license or promote best practice. I have found very little evidence on creating guidelines.
Laura