Medication Range Doses-What if Patient Wants Less? - page 2

Sorry if this seems like a pointless question! Say a doctor orders Ativan 0.5mg-1mg IV PRN q 6 hrs. What if the patient says that they want only 0.25 mg? Do I have to call the doctor and get a new order? Or can I just adjust... Read More

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    Quote from nu rn
    Um, no I don't think so. Who's to say that shouldn't be 0.5 mg qh? That's turning it into a completely different order. If it's written 2 mg q4h, then it's 2mg q4h. However, they can write the order as 1-2 mg q4h & then you could start with the 1 mg. My understanding is that if that is not effective, the 2nd mg can be given, but the 4 hrs starts with the 2nd mg, not the first. I try to follow up quickly with the pts on pain relief so that if the additional dose is necessary, it is given about 30-45 minutes after the first. This doesn't happen often though. Usually, its a pt who thought 1 Norco would be all they would need to get through the CPM session but realize once it starts that their knee was quite a bit more sore than they realized. We usually have protocol orders for 1-2 Norco q4h.
    You can not think so but that's how things worked in my hospital. We gave half doses or 3/4 doses all the time and as long as the maximum wasn't exceeded in the ordered time range, no one seemed to care. See the post I was responding to. Every facility is different in their policies/procedures.

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  2. 1
    I have a dumb question. What is the point of ordering a PRN med q 4-6 hours? You might as well just write q4 hours. The "to six" part of "every 4 to six hours" seems unnecessary and pointless. The q4 part is all that really matters.
    loriangel14 likes this.
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    As for the topic of the thread, if I have an order hay reads 'give two norco PRN' I sometimes give only one norco if that seems more appropriate. It seems implied that, if you can give two, you can also give just one.
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    I would like to point out that the case where I really won't consider giving less than the dose is insulin. Either give it or hold it. With sliding scale, the doses make sense and there's not room, usually, to wonder about it but the patient may refuse it. I haven't seen too many who do refuse their insulin, but it could happen. With Lantus or glargine insulin, it may seem like the prescribed dose is excessive. I will either give and make sure the food intake is adequate, or hold and call the physician and explain the situation. I won't attempt to figure out what the dose should be.

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