INTRODUCTION: The Arizona State Board of Nursing has received questions regarding the scope of practice for RN’s to hold medications without physician orders prior to dialysis. It is the intent of the Board of Nursing that these answers will serve to promote safe nursing practice in holding medications prior to dialysis.
BACKGROUND: Withholding medications, primarily antihypertensives, prior to dialysis has become a frequent occurrence. Due to the frequent tendency for patients to become hypotensive during treatment, and also the “pulling off” of medications during the dialysis procedure, nurses often withhold medications. It has often been considered a ‘community practice’ and has been taken for granted that medications could be withheld whether written orders by the physician are obtained or not. Then the withheld medications are given post dialysis, usually with communication to the physician on the patient’s tolerance & outcomes for a successful dialysis and the physician’s determination of the next dialysis, i.e. bath solution, length of dialysis, weight loss/gain, etc.
QUESTION: Is it an acceptable practice for a nurse to withhold medications prior to dialysis without a physician’s order?
ANSWER: It is not acceptable for nurses to withhold any medication without a physician’s order. An order must be obtained. This order may be written as a standing order or an order written for the individual patients.
RATIONALE: Although the Board of Nursing recognizes nurses often feel they are acting as the patient’s advocate and in behalf of the patient’s best interest for a safe and successful dialysis, it is essential that the nurse is following a physician’s written order to withhold medications. This will ensure communication and provide knowledge-based decision-making by the team, within the nurses’ scope of practice. It is the intent of the Board of Nursing to promote safe nursing practice in patient management throughout the entire dialysis treatment for each patient.