These drugs work by making the muscle layer of the blood vessel contract, causing the blood vessel to tighten up and become narrow. We often need to use medications to raise the blood pressure. The treatment for a low blood pressure depends upon the underlying cause. Systemic diseases such as infection, allergic reactions (anaphylaxis), certain type of lung disorders and brain injuries can also cause blood pressure problems. Low blood volume (called hypovolemia), abnormal heart rhythms (called arrhythmias) and heart muscle damage are common reasons for low blood pressure. The blood pressure can become too low for many reasons. The blood pressure is often low during shock. Shock is a term that is used to describe a patient whose tissues are being deprived of oxygen. Injury due to low oxygen is called ischemia. Because oxygen is carried to the tissues in the bloodstream, a reduction in blood flow can cause injury to the body organs from low oxygen levels. When the blood pressure is too low, the flow of blood to the organs and tissues decreases.
Low blood pressure is called "hypotension" ("hypo" means decreased "tension" refers to pressure). Patients may need help to correct a low blood pressure. Furthermore, TJC continues to raise the standards to the point of discouraging nurses away from the bedside while preventing CMS from paying hospitals who desperately need their pay.The most frequent reasons for admission to a critical care unit are to receive support for a low blood pressure or breathing difficulties.
Nurses in an ICU setting have received the training and classes to be able to titrate an infusion without strict parameters. "The titration parameters recommended by TJC are profoundly unrealistic in an ICU setting. Some respondents suggested that the standards, which they said are both stressful and demoralizing to nurses who expected more autonomy, may drive nurses out of the profession: These strict titration parameters do not take into account differences between patients (sensitivity to med, pain med tolerance, other hemodynamic issues, etc.) - which is why nursing judgement/autonomy should not be limited by these TJC requirements." "In my experience, the providers writing the titration amounts and frequency have little or no experience with actually titrating drops at the bedside. More than a year after the standards were announced, Davidson said she was still hearing rumblings about this "no-win situation" in which nurses couldn't adhere to the standards, and middle managers, whose job it is to hold nurses accountable, felt conflicted because they also knew how difficult the standards were to follow.Ĭomments also described how the current standards contribute to "suboptimal workplace wellness" as a result of "increases in workload, burnout, physical risks, and inefficiencies and a sense of nursing practice being devalued."Īnd more than one respondent argued that nurses are often more proficient in titrating infusions than the clinicians giving the orders: The surveyed nurses were often "frustrated by being unable to comply with the standards, unable to provide safe care, and fearful of reprimand for deviating from orders," the authors stated in a separate American Journal of Critical Care article.Īnd many facilities don't have doctors on their units, which forces nurses to have to wait for a reply before they can intervene, Davidson noted.
"Those changes are great, but they don't actually tackle the issues that are causing harm."ĭavidson and colleagues also conducted a thematic analysis to better understand the "practices and perceptions" around the commission's titration standards, and identified two key themes: Harm, such as concerns for patient safety, and professionalism, including the "erosion of workplace wellness." "It's not like they ignored us, the research wasn't complete yet," Davidson said, of the Joint Commission. The survey revealed nurses' major concern was the lack of autonomy over the frequency and the amount of titration. The changes "softened" the standards and reduced some of the burden on nurses, Davidson said, for example, by allowing "batch documentation" (also known as "block charting") - recording multiple incremental doses in one batch rather than immediately after each dose.Īs of January 2021, nurses can now decide the order of titration when multiple infusions are required, and "intermittently pause and restart titration infusions" if hospital policy allows it or an order is given to describe the restart dose, Davidson and her colleagues noted in the study. TJC updated the titration standards multiple times in 2020 in collaboration with the American Association of Critical-Care Nurses (AACN).
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