My husband, J, was admitted from the ER with a bowel obstruction. He is a heart patient as well and suffered a heart attack in 1998. Since then he has been on three heart medications, one of which is Metoprolol. During his stay he had two NG tubes inserted and, therefore, could not take his dosage orally. The IV injections of Metoprolol that he was given did not match the mg that he was accustomed to. We questioned multiple times to many different caregivers why he was not being given the proper dosage of Metoprolol; the answer was always that his blood pressure was too low. We explained every time that the medication was not to reduce high blood pressure in his case, but rather it was to regulate his heart in other ways. Nothing changed, even though we tried so many times to correct his dosage.
Two days later, J suffered a sustained Afib event. We were shocked because until then we were unaware of any problems with Afib. After this we found through the pacemaker readout that J did have several events over the years; although, none as sustained and prolonged as this one. J's long-term cardiologist never mentioned these to us, which means to us they had not been a concern to him. During the Afib event, a doctor apparently ordered Lopressor or Metoprolol to be given to J intravenously, which within minutes brought his heart back to normal rhythm and his pulse from a high of about 145 to normal as well. We were upset that the event happened to begin with, as it seems likely that if J were given the medicine in the proper dosage it may not have occurred.
Natalie was J's nurse the day after the Afib event and, as we did many times before, we explained the Metoprolol situation to her. She is the only person who asked us if anyone had shown us the medication list; we said no. As we reviewed the list with her she told us that the parameter to be given Metoprolol was that blood pressure had to be higher than a certain number. Of course, J, having naturally lower blood pressure readings, was not given the medicine many times because he failed the parameter. We asked Natalie why there were no special conditions to that parameter, as in J's case a heart attack patient with low blood pressure. She said she would discuss this with her superior and get back to us. Again, showing us that much care and concern and the initiative to change something that clearly was not working, as in J's case. She told us later that she had successfully been able to have the parameter changed for J to a lower blood pressure number and he has now been given the correct dosage, finally.
Perhaps this experience can have a positive effect on other patients such as J, who fall outside of "normal parameters". We so appreciate that Natalie took this initiative and helped ease our anxiety over this medication issue. We struggled to get our point across for two days until she finally acted to change it. Natalie is the most compassionate and caring nurse that my husband has ever had. She has given us extremely good care and I say "us" because she is concerned with the family members as well as her patient.