Withholding medications, primarily anti-hypertensives, prior to dialysis is not uncommon. 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 an authorized health care practitioner are obtained or not. Then the withheld medications are given post dialysis, usually with communication to the provider on the patient’s tolerance and outcomes for a successful dialysis and the provider’s determination of the next dialysis. It is not acceptable for the registered nurse to routinely withhold any medication prior to dialysis without an order from an authorized provider. This order may be written for an individual patient or through a standing order. The NCQAC’s Standing Orders and Verbal Orders Advisory Opinion and Verbal Orders provides additional guidance and recommendations.