[GradRNKylie]

I need to have some medication clarified. I know the 5 rights of medication administration, one of them being RIGHT DOSE, which is the focus of this topic. Whilst on Nightduty there was this young girl who was post op fractured mandible from MVA. A PRN Morphine order of 7.5mg Morphine q4h. The nurses that finished before I got into it the WORK MODE was looking after her and gave this young girl say 2.5mg of Morphine S/C. I suppose that nurse gave that dose because of the pain rating the young girl stated at the time.

I always thought, you can give up to 7.5mg, but the order had no parameters just a set dose to give. Therefore, was it a medication error to give less than the prescribed dose based on pain scale???

[fultzymom]

The only way we can adjust a dose is by the parameters a doctor sets. For example, many doctors will write Percocets 1-2 Q4HR PRN. Then you could give one or two based on the patients rating of pain and what they wanted. If it was a set order, then she should have given the set dose.

[RNLisa]

Where I work, the docs cannot write a range order, for example, they cannot write Percocet 1 - 2 tabs PO q6 hr PRN pain, they have to maybe say, For pain scale 1 - 5, give Percocet 1 tab PO q6 hr PRN pain, and for pain 6 - 10, give Percocet 1 tab PO q6 hr PRN pain.

If the order states 7.5 mg, and you know that is the correct dose, then you give that.

[canoehead]

Hospital policy may cover her, but otherwise she can't change the dose.

[RNsRWe]

Originally Posted by RNLisa

Where I work, the docs cannot write a range order, for example, they cannot write Percocet 1 - 2 tabs PO q6 hr PRN pain, they have to maybe say, For pain scale 1 - 5, give Percocet 1 tab PO q6 hr PRN pain, and for pain 6 - 10, give Percocet 1 tab PO q6 hr PRN pain.

If the order states 7.5 mg, and you know that is the correct dose, then you give that.

Our docs routinely prescribe 1-2 Percosets for pain; we pick it up for our MARs as "1 tablet for moderate pain" and "2 tablets for severe pain" (or if 1 tablet ineffective). Same thing for 4-6 mg morphine: gets written up as 4 mg for moderate, 6 mg for severe (or if 4 mg ineffective).

But in no instances can we decide to give half a percoset. If the order says 7.5 mg, then either 7.5 mg is given, or none is given (and MD called for new order). HOWEVER, I have had pts know that, say, 8 mg is ALOT for them (and I don't hesitate to tell them so, if applicable), and had them "refuse" half of it. A patient has the right to refuse any amount of medication, so if the PATIENT refused half of the dose, that's fine, and it's documented. The MD then can make a change if warranted. Or not.

But that's different than the nurse re-prescribing the dose on her own.

[faithmd]

We regularly give partial doses of IV pain meds. Our docs used to be able to write a range, but the pharmacy stopped placing the range on the MAR, it now just lists the max dose. Sometimes a patient may not need 7.5mg of Morphine, maybe the last time she got 7.5mg she didn't need/want the whole dose for whatever reason, but if you call the doc to change the dose to 2.5mg, then when she's up and ambulating and talking during the day and needs 7.5mg, you're hosed. I was always taught it is fine to give less than the dose of a pain medication (though I don't cut pills, either) and titrate up to the max as needed.

Though if it were me and someone came at me with a needle to give me something that could be given in my IV, I'd stick a needle in the doc that wrote that antiquated method of delivery!

[cardiacRN2006]

Originally Posted by faithmd

I was always taught it is fine to give less than the dose of a pain medication (though I don't cut pills, either) and titrate up to the max as needed.

Yikes! It's not fine to do this. It's practicing medicine without a license.

Range doses aren't appropriate unless they are specific. 4mg Morphine for a pain scale of 1-4, 6mg morphing for a pain scale of 5-10.

If the order states 7.5mg, then she gets all or nothing. If the pt or you feels that the dosage is too high, then it's up to you to get an appropriate order to cover her.

[dijaqrn]

This is called prescibing and can get you in a whole lotta trouble here in California. In areas like PACU anesthesia uses ranges and nurses give fractional doses but there must be orders to cover this!