BID vs q 12h

  1. I've got a question: Do your Docs ever write for anything to be BID, QID, 3 times/day. etc. and if they do, what time schedule do you put the med/treatment on?

    The reason I am asking, is that we recently had a flap over a resp treatment ordered BID. All of us NICU people automatically think "q 12 hours". Our resp therapy dept, however, says that means 2 treatments between the hours of 8am and 10pm.

    Do our RTs lack critical thinking skills or do our Docs have to write orders like they do in the adult world?
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  2. 16 Comments

  3. by   renerian
    We scheduled bid around patient issues, like dressing, hs care, am care and such. In home health we did the same. In facilities I have worked on they had specific times they used for bid. Q12 is just that. Does that help? I agree with respiratory.....

    renerian
  4. by   Mofe'ny
    BID in our NICU is Q 12 hours. We have fought with pharmacy and respiratory about this too. Our neo & peds told them that Babies are different!!!! We schedule resp. treatments around feeding / Hands on times. Sounds to me like your respiratory dept. needs education about developmental care.
  5. by   prmenrs
    No matter what they write, bid=q12, tid=q8, and qid=q6 in our unit. As they get closer to going home, we do try to get all the meds given during the day, not in the middle of the [yawn] night.
  6. by   dawngloves
    Depends on what it is. The nurses can change the schedual of a med to revolve around things, like Fe with feeds or MSO4 before hands on. I just did this with a med that you couldn't give with food, I changed the time to an hour before feeds.
  7. by   nell
    Thanks for the replies.

    Mofe'ny, you get the problem exactly. It doesn't matter how the Neo orders anything for us; we just put it on the appropriate schedule - taking into consideration the baby's schedule. The problem is when orders are given to RTs and the Neo just says BID or QID expecting that the RT will schedule it around the clock. They were suprised and dismayed to find that the RT wanted to give QID treatments at 9-1-5-9!

    I tried to explain the 24hr nature of NICU to no avail.... (ICU is 24 hr too he said...)

    Pharmacy too.... If my Epogen doesn't arrive by my hands-on feed at 4pm, then it won't be given until my next hands on at 8pm. These people just don't understand that we are caring for a different kind of critter.
  8. by   ?burntout
    I work pulmonary/med/surg and this is our time schedule:
    BID-9am/9pm
    TID-9am/1pm/5pm
    QID-9am/1pm/5pm/9pm

    But if it is PRN like Tylenol 650 mg po qid prn-we give it q6hrs

  9. by   mark_LD_RN
    depends on hospital policy. BID means twice a daY and most places i work resp would do them during waking hours. were as Q12 is every 12 hours.
  10. by   Mimi2RN
    In our ICN, bid is q 12, qid is q 6, everything around the clock, and most po's given with feedings. The pharmacy sometimes has problems understanding that-when they send the med late, and baby has already eaten, it will wait till the next feeding. It's just a baby thing......
  11. by   nell
    No offense to all of you non-NICU folks, but that is the point I was trying to make: that it is a different world in NICU, and RTs that are trained in NICU should also recognize the uniqueness of the neonate and be able to adjust orders to meet their special needs (i.e. around the clock).

    If we ever needed a secret way to tell REAL NICU nurses from imposters (like when the Christians would draw a fish in the sand...) we could just ask them to schedule a QID treatment and see if they schedule it for 9-1-5-9 FRAUD!!
  12. by   Vsummer1
    Originally posted by nell
    No offense to all of you non-NICU folks, but that is the point I was trying to make: that it is a different world in NICU, and RTs that are trained in NICU should also recognize the uniqueness of the neonate and be able to adjust orders to meet their special needs (i.e. around the clock).

    If we ever needed a secret way to tell REAL NICU nurses from imposters (like when the Christians would draw a fish in the sand...) we could just ask them to schedule a QID treatment and see if they schedule it for 9-1-5-9 FRAUD!!
    I am a student (just so ya all won't flame me too badly) and this is what they are teaching us:

    1) If a doctor orders Q12, it is just that. Every 12 hours.

    2) If a doctor orders BID, it is twice per waking hours.

    So, that to me would then mean that if a DOCTOR doesn't know to order his NICU meds as Q12, the NURSE shouldn't need to change a BID order to be every 12 hours. It is the DOCTOR messing up the order by not ordering his NICU meds right! So, shame on the doctor, not the RT who is just following a BID order.
  13. by   ?burntout
    Originally posted by nell
    No offense to all of you non-NICU folks, but that is the point I was trying to make: that it is a different world in NICU, and RTs that are trained in NICU should also recognize the uniqueness of the neonate and be able to adjust orders to meet their special needs (i.e. around the clock).

    If we ever needed a secret way to tell REAL NICU nurses from imposters (like when the Christians would draw a fish in the sand...) we could just ask them to schedule a QID treatment and see if they schedule it for 9-1-5-9 FRAUD!!
    GEEZE!!!!!! SORRY!!!!!!!!!!!!:uhoh21:

    I know I'm not a NICU nurse-I know it is an entirely different type of patient-I have witnessed it first hand........mean no offense-but I'm having a bad day.........sorry
    Last edit by ?burntout on Nov 5, '02
  14. by   prmenrs
    An RT working in NICU should automatically change a qid order to q 6h, just like the nurse will. (Of course, the likelihood of a resp Rx being given ON TIME seems miniscule, but...that's an entirely different issue.)

    Don't forget what the rationale is for giving meds during waking hours: so that the pt can be allowed to sleep at night and not have to be awakened for meds.

    This rationale is not applicable in the NICU because the babies' VS, feeding, treatment, etc., all go on 24 hours/day. The babies sleep between these care-giving episodes. (Any mom can tell you babies eat, sleep, play and poop 24/7.) You're also concerned w/maintaining consistent blood levels of the drugs, babies metabolize meds differently, and so giving meds like you do to an adult might not be what's best.

    This is info that is helpful to know, I hope, if you're a student, so that you can appreciate that what you learn for the general population may nor work in a specialty area. Flexibility. What they're teaching you is correct, applied to adults, not to NICU pts. As a student, it's more imp't to the general stuff, learn the specialty stuff later.

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