Is Ativan 10 mg po per dose too much?

Nurses Safety

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Last night a 49 year old male patient was admitted to our med surg unit with R/O PE which was later ruled out. He also had a history of anxiety. Admitting doctor ordered 5 to 10 mg Ativan po Q 4hrs prn. Evening shift nurses questioned it and called the doc on call who quickly changed it to 1 mg Q 4 hrs prn. This morning, the primary doctor comes in and throws a huge fit on the floor. Why didn't my patient get 10 mg Ativan last night???. I explained to her that we have a right to question orders like that and her partner on call changed it. Our pharmacy states max daily dosage should be 10 mg divided over 2 to 3 doses. Also, this patient had taken Ativan only one other time in his life. So...could I get some feedback? I had to write an incedent at the doctors request. Thanks fellow nurses :)

Well, the story gets better. We ended up giving the patient 5 mg of Ativan, the nurse refused to give more. The patient was then discharged to home. The nurse went over his discharge papers and told him to call when his ride arrived to pick him up. After the nurse left the room, the patient got up, got dressed and walked out of the hospital and drove home. We had no idea he left. His wife called a half an hour later and was screaming at me that we screwed up twice in 24 hours and how could we have let a patient with that much Ativan on board, drive home. Said she would be in touch with administration. Oh how I love being in charge.

:eek:Which doctor is requesting the insident report? Maybe the doctor that ordered the ativan should be written up:uhoh3:

I definitely would write up an incident report that included your actions in calling to question the order and the doctor's reacton. Did the doctor change the order to 10mg again the next day. That is a very high dose for Ativan.

Specializes in Psych, M/S, Ortho, Float..

Holy cow, what a mess. I would not have given 10 mg Ativan PO. In fact just last week I had a pt getting 2 mg po qid and he was stumbing around peeing in garbage cans and couldn't hit the toilet even when he was awake enough to try, and this guy had been a hard core drug abuser. Had it decreased and they added Olanzapine for the psychotic behaviour, which is working much better. Ativan is good for very short term anxiety, but there are better meds out there for the long term chronic anxiety patients.

You done good. Ativan does really wierd things to people's brains. I had too many people go bonkers on it to make me comfortable giving more than 2 mgs at a time. Even then, I watch them like a hawk for 4 hours.

So this guy can drive home on 5 mg of ativan, sure sounds like he needed 10 after all !! haha...But seriously, thats a high dose that we seldom see, and I would not want to give that either for fear of severe reaction.

why is valium 10mg po acceptable but not ativan 10mg po?

and valium has a longer half life..........just thinking aloud.

That would be to much for some one new to the benzo family of drugs but, they were detoxing him from his XanaX habit Dumby.

You really do not need to play with life's.

That would be to much for some one new to the benzo family of drugs but, they were detoxing him from his XanaX habit Dumby.

You really do not need to play with life's.

Dear lord, you administer meds and you write and spell like an 8 year old?

In 23 years in ED I've never given more than 6 mg *IV* (2mgs at a time) over maybe an hour due to severe uncontrolled aggitation.

Remember the little rule in school - if you find yourself opening more than 2 unit doses for something CHECK the order... something's wrong. Ativan po comes in 1mg unit doses, so you'd have to open 10! Red flag right there!!!

Always be ready to tube someone when you use any kind of sedation. You NEVER know how people are going to react.

Specializes in LTC, Memory loss, PDN.

Didn't the order say "5 to 10mg Ativan PO"? That in itself shows it's a crappy order. As long as the doc chooses throwing a fit over providing a rationale, there'll be no mega dosing.

I can't even believe what I am reading. 10mg by mouth? When they have no tolerance? Sounds exactly like a valium mixup to me. You did the right thing. You have to question every order these days. They gave my father 5 mg of ativan in his line and put him in a medicinal coma for two weeks. You never know. Kudos to you!

Specializes in Psych ICU, addictions.

I agree: it seems like the doctor may have meant to write it for Valium, since that dosage range would fit diazepam perfectly.

I've worked in detox and I've never given a patient more than 2mg of Ativan at a time max. I've had patients come in that have been using 6, 8, 10 and more mg of Ativan at a shot--among other drugs--but I've never doled that amount out to anyone. And if we are going to use a benzo to detox, it's either going to be Librium or Valium: nice long-acting benzos that will do the job right...we're certainly not giving him Ativan or Xanax.

Specializes in Psych, Corrections, Med-Surg, Ambulatory.

I love that she made you write an incident report. Now Risk Management gets to see how she prescribes.

Specializes in PACU.

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