Can you solve this mcg to mg conversion?

[Emergent, RN]

I was working at my Per Diem job yesterday. One of the acute care nurses came to me, baffled by an order for Fentanyl that read 100mcg/2ml give 0.025 to 0.05 mg. First of all, I think that's a dumb way for pharmacy to transcribe the order. But, nevertheless, I couldn't get this fellow to understand how much to give. He told me that he is usually good at math, but I kind of doubt it. I diplomatically walked him through it several times, not giving any hint that I thought he should know this. It's important for us nurses to be able to ask our co-workers to double check without them rolling their eyes.

So, allnurses cohorts, is this nursing 101 or is this a confusing order? Can you figure out how many ml to give?

[wanderlust99]

I calculated it and I am baffled too. That is a lot of fentanyl. What did you get?

[loveofrn, BSN, RN]

100 mcg to mg is 0.1

give 0.25 mg= (0.25*(2ml/0.1 mg)=5ml

give 0.5 mg= (0.5mg*(2ml/0.1mg))=10 ml

[been there,done it]

Yep, very basic math. Kudos to your for not rolling the eyes.

A very strange order though.

[wanderlust99]

I got that too loveofrn. Is this for general anesthesia? LOL. I wonder if they meant to write for 0.025-0.05mg Fent?? That would make more sense.

[VANurse2010]

I agree with you that it's simple, stupid math. However, Fentanyl is typically dosed in mcg, and it needs to be written that way to avoid medication errors, period.

[Emergent, RN]

Whoops, I even made an error in my opening post! I agree, it's confusing. I meant. 0.025 and 0.05mg! Embarrassed! I corrected it, meant to put that extra 0 in there.

[Emergent, RN]

Which goes to show, the pharmacy order was confusing.

[AJJKRN]

I can see where he was confused, I personally only get orders to give 25 to 50 mcg of fentanyl ivp at a time...if I'm reading the post right without any typos, the doc wants a dose from 250 mcg (5 mL) to 500 mcg (10 mL)...? Talk about a Pt that can tolerate their narcs

[loveofrn, BSN, RN]

Nothing

[MunoRN, RN]

It can be figured out, but then again so can "Fentanyl IV pi/square root of speed of light x10 to the -24000 mcg". My biggest concern is the potential to easily misplace the decimal, which appears to the case here since the order is for 250-500mcg and 25-50 is the standard order.

The least confusing form should always be used, which means using mcg for fentanyl IV push orders since it is dispensed amounts measured in mcg. Personally I'd tell the pharmacist they need to re-write it, and I don't actually know of any pharmacist that wouldn't agree it needs to be re-written.

[emtb2rn, BSN, RN, EMT-B]

500 mikes of fentanyl will fix their pain along with that annoying breathing habit.