How about this for an order? - page 4

This may just be my naivete or age showing but I saw a prn order from an old "breast man" that read verbatim "Ativan 1 mg p.o q 4-6hrs prn pain". Yuck :uhoh3: :angryfire... Read More

  1. by   Tweety
    Back in a day when mastectomies were kept overnight or for a day or two on our unit, I remember sometimes those women were in enough pain to recieve narcotics. (Our breast man started doing his surgeries as a day surgery, then retired, and the other breast man in the area uses another hospital for his inpatient surgeries, and I haven't seen any in a long time.)

    I hope you guys call him at all hours of the night asking for more pain medicine.

    But a lot of pain can be controlled with the power of the mind. When the patient asks for pain medicine and you approach the patient "here's your pain medicine", it might work.

    But I agree with the others, it's not the best first-line pain medicine.
  2. by   Tweety
    Quote from *PICURN*
    MD's aren't allowed to write "q4-6 hrs" they had to SPECIFY like "q4 hrs" or "q6 hrs"......at least thats the new policy @ my hospital
    We're just now beginning to address that issue. I think how we're going to handle it is the pharmacy automatically enters the order as "q4h" if the order says q4-6.

    I called a doc for the first time the other day to clarify "what does qd mean?".
    Last edit by Tweety on Jan 25, '05
  3. by   zacarias
    I personally don't mind 1-2mg q4-6 hrs type orders. I think it allows us to use our nursing judgement and gives us some leeway. Also, Do we really need a doctor to give us a rate for TKO? As a nurse, when I see a TKO order, I put it at 20cc/hr generally or even a little lower if there is something else flowing through same vein. While I do like docs to write clear orders...what's wrong with TKO or q4-6?
  4. by   needs help
    Just my 2cents worth. At my hospital we get q4-6 hours and 1-2 tabs (both prn) all the time with out any problems. I agree it allows nursing judgement. Also Ativan is sometimes used for some types of pain, although I'm not sure how much good it would do for mastectomies, I was given Ativan 1mg q4-6hours prn for muscle spasms from a neurosurgeon and it did help with the pain. I do agree totally that post-op patients should have stronger pain meds available than just tylenol and ativan. If the patient does not need the stronger med fine but it should be available in case thay do. If one of our MD's don't order pain meds I just call them at 2am when the patient wakes up and get an order, usually at that hour they are cooperative. (HA HA)
    Like I said just my 2 cents worth.
  5. by   Tweety
    Quote from zacarias
    I personally don't mind 1-2mg q4-6 hrs type orders. I think it allows us to use our nursing judgement and gives us some leeway. Also, Do we really need a doctor to give us a rate for TKO? As a nurse, when I see a TKO order, I put it at 20cc/hr generally or even a little lower if there is something else flowing through same vein. While I do like docs to write clear orders...what's wrong with TKO or q4-6?

    Because you would put it at 20 cc/hr and I would put it at 50 cc/hr. The rate should be specified.

    The q4-6 doesn't make sense to me if it's a prn med. Because anytime after four hours, be it 4.5 or 6 or 10 hours, the nurse can give it, using his/her own judgement. I definatley like dose ranges like 1-2 mg, but the frequency ranges don't matter to me, give the the lowest frequency and I'll take it from there.

    If it's a scheduled med, our pharmacy has policies as to what time to give it.

    What kinds of medications are you thinking the nurse can give q4-6h scheduled?
    Last edit by Tweety on Jan 25, '05
  6. by   Brita01
    Quote from jaimealmostRN
    I'm sorry, but I don't understand. The patient was a "breast man" who was lactating and the Dr. wrote a not very clear order for ativan

    I'm with you, begalli, I'm DYING over here. :roll
  7. by   sharann
    Quote from KarafromPhilly
    Two words: ethics committee.
    You think I should? Will I get fired? Our manager is pro-nurse but he is also an MBA and pro making happy docs.
  8. by   sharann
    I don't mind the 4-6 hour part, its the overall ignorance of the way he obviously thinks that bugs me. Ativan is a fabulous adjuvant med (to narcotics and NSAID's), and I insist on an Ativan order with my suspected DT's! I don't like the fact that he writes (pre-printed) for Ativan specifically for pain, and when I asked for alternate pain meds he said "give the 2 tylenol). This is 30 minutes post op. Thanks for the responses.I have to think on this one. May be one for Ethics(if we have one)
  9. by   General E. Speaking, RN
    I called a doc for the first time the other day to clarify "what does qd mean?".

    Really, 3rd shift guy? :icon_roll
    Last edit by General E. Speaking, RN on Jan 25, '05
  10. by   z's playa
    Quote from 3rdShiftGuy
    Back in a day when mastectomies were kept overnight or for a day or two on our unit, I remember sometimes those women were in enough pain to recieve narcotics. (Our breast man started doing his surgeries as a day surgery, then retired, and the other breast man in the area uses another hospital for his inpatient surgeries, and I haven't seen any in a long time.)

    I hope you guys call him at all hours of the night asking for more pain medicine.

    But a lot of pain can be controlled with the power of the mind. When the patient asks for pain medicine and you approach the patient "here's your pain medicine", it might work.

    But I agree with the others, it's not the best first-line pain medicine.

    Do you mean say "Here's your pain meds" and not give it to them?

    Or you do notice as soon as you approach a pt and say "Here's your pain meds" they quiet down because they know relief is in sight.
  11. by   begalli
    I called a doc for the first time the other day to clarify "what does qd mean?".
    We do this all the time because as we all know, JCAHO has us eliminating "dangerous" abbreviations. :stone

    If I don't bug the docs and take a verbal spelling out daily (instead of qd), or look over the docs shoulder as they write the order to make sure it's right, the pharmacy will send it back to get me to call the doc and get it "clarified" anyway. It slows the pharmacy and patient care down cause pharmacy won't make a drug available in the pixis until the order is written "properly" (emergencies excepted of course).

    We can no longer use:
    U
    IU
    QD
    QOD
    Trailing zeros (eg: 1.0 mg)
    MS
    MSO4
    MgSO4
    ug
    hs
    SC
    SQ
    d/c
    cc
    au, ad, as

    For the most part everything needs to be spelled out.

    Is that what you meant ThirdShiftGuy?
  12. by   SouthernLPN2RN
    I always set my rate so that a bag was used in a little less than 24 hours. I don't know if bag changes q 24 was policy, but I felt more comfortable doing it that way.
  13. by   KRVRN
    If a doctor ever orders something in cc's, we are to clarify with them that they really meant mL. It's basically like that for most, if not all, of the abbreviations begalli listed. (I'm not saying we religiously do this, but we're supposed to)

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