Titrating a pressor faster than ordered during acute hypotension — how do you handle documentation?

Had a situation where a patient’s MAP dropped into the low 30s and I titrated levophed more frequently than the ordered interval to keep them from crashing further. Patient stabilized, no adverse outcome. Notified the physician afterward, who was fine with the clinical call but wasn’t sure how it should be charted.

Got eaten by the charge nurse for not documenting as ordered in the chart.

But curious how others handle this in the moment when a patient is acutely decompensating and there isn’t time to call first.

∙	Do you call before titrating outside the ordered parameters, even when things are moving fast?

∙	How do you chart a titration frequency that deviates from the order, when it was clinically warranted?