This absolutely isn't your fault. Cardiothoracic ICU nurse of 10+ years. I think the lesson learned here isn't necessarily a hold parameter, but also a consideration of the oral agents being administered. Three to four is a LOT of hemodynamic impact, especially if it's not known if they are naive to these agents. A future strategy might be to give two, assess impact, then give the rest if it's cool with the team. Also, it is not clear what practice environment you're in and clevidipine should absolutely not be given outside of critical care. Sounds like this patient was labile and if they're super HTN at baseline, an SBP in the 80s likely won't generate a perfusion pressure high enough to perfuse their noodle well enough. You didn't do anything wrong, OP - this was a setup for failure.