Ambien order did I make a mistake - page 2

by nakinok 3,965 Views | 22 Comments

The order reads Ambien 5mg 2tabs po qhs, mrx1 what do you think this is? I thought original Order of two 5mg tabs can be repeated once if needed. I was told you only repeat with one 5mg tab. I am confused. What do y'all think?... Read More


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    Quote from nakinok
    The order reads Ambien 5mg 2tabs po qhs, mrx1 what do you think this is? I thought original Order of two 5mg tabs can be repeated once if needed. I was told you only repeat with one 5mg tab. I am confused. What do y'all think?
    The way it's written, I would have repeated the original dose and given the two 5mg tabs as the repeat. Can't say I agree with the dosage (though I have seen 15mg and even up to 20mg given, but both rarely) but that's how the order was written. The total dosage alone should have prompted a call to the prescriber.

    If the prescriber only wanted 1 tab to be given for the repeat, then it should have been written to reflect that: Ambien 5 mg 2 tabs PO QHS, may give 1 additional 5mg tab in an hour if needed.

    I often see "MR" for "May Repeat," but it's not an official designation. It would be better if it was specifically spelled out.

    At any rate, if you have questions about either the dose or the order, always call the prescriber for clarification.
    Last edit by Meriwhen on Dec 4, '12
    nrsang97 likes this.
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    Eek. Ambien is evil. Crazy stuff that drug causes. But I would interpret that order to mean 2 5 mg tabs * 2 if necessary.
    turnforthenurseRN likes this.
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    Quote from nakinok
    Thank you so much. I read it to mean repeat original dosage as well. I am going to call my nursing manager to clarify again myself. I definitely don't want to be in error and jeopardize a patient. Also I don't want to give the wrong dosage because others see this as a a repeat half dose when not stated as MRx1 as a a half dose. I am a new nurse and have been wrenching my brain on this. I so appreciate your input.
    What you need to do is to make sure your orders never, never, never say something like "Drugname 5mg, two tablets." What they should say is, "Drugname, 10mg." Then this whole confusion completely goes away. Your pharmacy should send a memo to the physicians and NPs who write med orders and a copy should be posted at every desk. If an order is written like yours, call them up and get it rewritten to standard of care.

    Now, if you have people who can't figure that 1mg is one half of a 2mg tablet, or that 10mg is two 5mg tablets, then you have bigger problems to deal with. But still. Standard of care for writing drug orders is to give the dose, period.
    dudette10, nrsang97, Wise Woman RN, and 1 other like this.
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    Quote from GrnTea
    Now, if you have people who can't figure that 1mg is one half of a 2mg tablet, or that 10mg is two 5mg tablets, then you have bigger problems to deal with. But still. Standard of care for writing drug orders is to give the dose, period.
    I know that, you know that, I think most nurses know that. However, there are some pharmacies who don't know that and if they don't stock 10s, will insist the order be written as 2 5s before they fill it. And sadly, I've come across nurses who WON'T give the medication if it's written for 5s and all they have are 10s.
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    If all you have on hand is 10s, you can't give a 5.
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    Quote from CapeCodMermaid
    If all you have on hand is 10s, you can't give a 5.
    You could cut a 10 to make the dose of 5 if the tablet is scored.
    nrsang97 likes this.
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    Get the rx clarified, rewrite, and be done wih it. Doesn't get easier than that.
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    Aside from the approved abbreviation issue and the dosage issue (I've had many patients who take 20mg regularly on who takes 70mg every night), the order is pretty clear. Writing the order as 5mgx2 is unnecessary but it's still a dose of 10mg, there's only one dose listed in the order, if it was a range order that would be more confusing. If the doc writes it as the square root of 20+75mg it really makes no difference, the dosage in the order is still 10mg. So repeating the ordered dosage x1 would mean repeating 10mg.
    nrsang97 and BrandonLPN like this.
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    If I have to hand write an order for 10mg of Ambien qHS, and I know we only carry 5mg tabs, I prefer to write it as 5mg 2 tabs. I don't know whether this is official "best practice", but it's how we do it. And we under line the dose number and circle the number of tabs. When you're passing meds to 40 plus residents, it helps to have these little cues.
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    As for the "may repeat" bit, wouldn't it make most sense transcribe that in a separate box on the MAR as a PRN?


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