[FLArn]

That order is perfectly clear if you are a hospice nurse as we are permitted to titrate meds to acheive symptom control. You start with the lowest dose and titrate up until you have controlled the symptom. You just have to keep track of what you've given at what time so you don't exceed the maximum dose ordered within any rolling time period. (e.g 0.5 - 2 ml Roxanol q 2 hr prn if 0.5ml given at 2:00 pm - no more than 2ml given before 4:00 pm)

[lil' girl]

Originally Posted by GLORIAmunchkin72

Orders should be clear and unimbiguous.

Yep! They tell us to write um so that a third grader can read and understand.

[bullseye]

I am confussed, whats wrong with the order? The order reads 5-15mg of Oxycodone every three hours as needed for pain. If the patient received 5mg at noon and it was ineffective, you can give up to 15 mg of oxycodone. At 1pm or 1am you can give anther 5mg or you can give 10mg of oxycodone. The order did not say if you give 5mg at noon you cannot give any more medication for the next three hours. The ordere reads that you can give 5-15mg within that three hours.

[Babs0512]

I interpret it as you do, and that is how we do it in our hospital. The assumption is that based upon your nursing judgment, and the patients complaint of pain, you can choose which does to give. 5,10 or 15mg.

I don't see it as you can wait 30 min and "give another five" and time the three hours from there. I wouldn't interpret it that way. You can always discuss the order with the physician to see how he meant the order to be.

[GLORIAmunchkin72]

Baabs, I agree with you. And the order should also include the dosage appropriate for the pain level such as moderate, mild and severe.

[softstorms]

sounds like we are all "guessing at the Dr's orders". One call could give us the ans. Our protical tells us that we can only start at the lowest dose and work our way up, defined by the pts. pain responses.

[DDRN4me]

I would not accept an order like this . I would ask that the MD write for a clear dose at a clear time. Ie; give 5 mg at 12 noon and may repeat x2 ; not to exceed 15 mg q 3 hours.

[SixFive]

I think it's a bad order, and in general all "range" orders seem to always lead to confusion as can be attested to by the responses in this thread.

We don't accept range orders at my hospital, and if one is given, it has to be clarified/rewritten.

[erinn429]

How we were taught is that you can give UP to 15 mg within 3 hours, but you cannot give any more from the last point in which they received the max dose.

ie. If you gave 5mg at 1200, and then 10mg at 1300, you cannot give any more until three hours after they reached the max dose (1600).

[cherrybreeze]

Originally Posted by queenjean

We do it *your* way at our hospital, with the key factor being that, if you first gave 5 mg at noon, and then at one gave 10 mg, the pt wouldn't be able to have any more until four (three hours after last dose), and you bet next time I'd give the full 15mg.

I suppose it depends upon your facility. I know that if I gave 5 mg, and then called to get an order for more, any of our docs would not be pleased, their response would be -- give the other 10mg and why exactly did you call me on this?

I do it this way too. For another example, if one or two Vicodin are ordered every 4 hours as needed, you can start with one. If in an hour it wasn't effective enough, you'd give the second. HOWEVER, I would count the next four hours as being from the time of the second pill. After that four hours, I would give two right off the bat. I make the patient aware that if they want the second one, they'll have to wait longer, or let them decide to ride out the rest of the time and get the two when able.

Hope this helps.

As a general rule, I would think, you'll learn pretty quick what works best for the patient, and then go with THAT amount every 3 hours. I do what I can to keep the doses all at once, with the correct time in between.