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By Ashley Gay, PharmD

Gayco Consultant Pharmacist

Many cardiac orders include parameters to hold the medication for blood pressure or heart rate below a specific reading. Examples include:

  1. Carvedilol 12.5 mg – Give one tablet by mouth once daily; hold for SBP < 110 or heart rate < 60.
  2. Digoxin .125 mg – Give one tablet by mouth once daily; Hold for pulse< 60.

Vital signs must be monitored and documented immediately before administration when parameters are included. They should be in a block below each medication order on the MAR. Vital signs taken every shift are not sufficient. A similar situation is PRN cardiac orders such as Clonidine 0.1 mg tab – Give one tab by mouth every 6 hours as needed for SBP > 160. In this case, blood pressure must be monitored and documented every 6 hours around the clock.

These are easy tags given by surveyors but can be easily avoided. I recommend asking the prescribing physician to discontinue the parameters if the resident’s vital signs are stable. I have also suggested adding the following statement to PRN cardiac orders, such as Clonidine, “When detected on weekly blood pressure readings.”