BID strictly every 12h or just twice a day?

[krg8089]

I am a new grad and just started my first nursing job. I was doing med pass and a patient asked me for a prn pain med that was BID. I told them they had just had it about 5 hours before so they could'nt have it till later and their argument was that they just have an allotment of twice a day, but not necessarily 12 hours apart and that no other nurse waits 12 hours in between doses. What is the correct way to go about that?

[OnlybyHisgraceRN, ASN, RN]

When in doubt you should always clarify with the doctor. I know it may seem silly calling the doc for this however, if your supervisor does not know and there is not set policy for BID times, then you would need to clarify.

Let others stated BID means something different to everyone. When I worked LTC, BID was 9a and 5p. Where I work now its 9am and 9pm.

Cover yourself always.

[Daisy_08, BSN, RN]

For me it would depend on the med. If is was Acetaminophen, I`d give it and let them know that`s it for the day, Hydromorph Contin - they are waiting. However in this case I`d do a good pain assessment and call up the doc for better pain control.

Our docs specify if they want BID to be specific, otherwise you use your critical thinking skills. 0800 and 1700 because it needs to be taken with food, or will keep them up at night or 0800 and 2100 because they get the best therapeutic effect by having it in there system at all times.

[Plagueis]

For PRN orders, our consult pharmacist discourages orders without a specific time frame. If an order is BID PRN, it should be written every 12 hours, or for TID PRN, every 8 hours. This is to prevent confusion about exactly how much time should pass between PRN doses. (I work in LTC.)

[msvmaier]

q12d calls for timing accuracy, b.i.d means dosing rate is approximate. I am a pharmacologist, not a clinical practitioner, so please put my following comments in the context of your clinical practice and administrative requirements. Legacy medications typically lack good pharmacokinetic data, and for the most part, dosing was derived anecdotally based on clinical experience. With modern technology (computers and analytical instrumentation), dosing rates are usually evaluated based on time-course data in plasma or at target tissues. These data may include averaging (area under the curve) and peak plasma concentration, both of which can vary between patients and between drug preparations. These concentrations are determined in large part, by absorption and clearance rates. There is more to it than that, especially the effects of dose escalation, but the point is, scientists who develop drugs nowadays usually have lots of pharmacokinetic data and they want dosing rates and timing to be very accurate.... so q12d means exactly that... every 12 hrs, not once in the morning and once at bedtime.