[limabean]

Can you give less than the physicians order? For example, I had a patient the other day who wanted only half of his Xanax. I said that I could only give him what was ordered (which I thought was right). He said, well that is what the nurses always do b/c I dont like taking that big of a dose. So I went out and asked my charge nurse and several other nurses who said that it was okay to give him half. Well I did it, even though I really think I remember that you can not do this. Am I right? And if I shouldnt have given him half do you think I should write up a med error and tell my supervisor? Thanks...I just want to do the right thing with this.

[twinmomoftwins]

The patient has a right to refuse the whole dose, however, you should contact the doctor to get an order for the half dose, then it won't be an issue in the future, and you've covered yourself. ALWAYS cover your license!

[michelle126]

Yep....what they said. I have a pt that only likes 1/2 DN100. I gave it to him, wasted the other half with another nurse then got an order for it.

[DutchgirlRN]

Our protocol says the patient can take a lesser dose and what is left over can be given within an hour, if not given in that hour then it is to be wasted.

[LoriAlabamaRN]

I've always been told that you can give a lesser dose, as long as you document on the MAR that you only gave 1/2 at the patient's request.

[suebird3]

Originally Posted by LoriAlabamaRN

I've always been told that you can give a lesser dose, as long as you document on the MAR that you only gave 1/2 at the patient's request.

I do the same.....covers my assetts (ie, license, etc.)

Suebird

[pediatriclpn]

CYA, give half the dose as requested by pt., and call the doc to get a new order. If the patient only ever takes half the dose, why continue to have the same order?

[Noryn]

It honestly depends on the facility, medication and the reason for the medication. It also may depend on the doctor as some could get upset. At my facility if someone only wanted lets say half of a Darvocet, I would give it, document it as such and save the half in their bottle. I would not call the doctor as I work night shift however I would leave them a note in our book.

I try to call the doctor the least I can and cover as many problems I can. I do have a few standing orders at my disposal and I never hesitate to call the doctor with any urgent problem. Instead of getting the order decreased to 1/2 dose I would get it changed to "Darvocet N100 1/2-1 tablet PO q 6 hours as needed for pain. That gives you some more options.

If it was something that was important such as Potassium in a patient who is hypokalemic I would document everything and tell the patient the risks involved.

A few months ago, I heard something kind of funny at work. In report the nurse was talking about a patient on a decreasing dose of Prednisone and the nurse said, "the patient stated she is going to refuse the lowered dosage and will continue to take the 20mg." I talked to the nurse and explained that it didnt quite work that way but I guess it is kind of funny because it does work that way in reverse.

[katfishLPN]

I would have called the doctor and let the MD know that the patient refused that dose and requested half the dose and got a new order. Remember to always err on the side of caution and CYA!!!!!!!!!!!!!!!!! Also document everything in the patients chart.

Right though this depends on what the med is, i.e. pain meds getting the 1/2 to 1 tab order is a good idea. If it is something like a thyroid med then some patient teaching is in order.

[Spidey's mom]

Originally Posted by DutchgirlRN

Our protocol says the patient can take a lesser dose and what is left over can be given within an hour, if not given in that hour then it is to be wasted.

Ours too. Check with your facility's protocols on meds or check with your pharmacy - I'll bet there is a policy and procedure for this. After all, there are p&p's for just about everything.

steph