number of doses/24 hours? help!

Nurses Medications

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Hi everyone.

A few of our where I work are looking at this differently, and I wondered how other's would interpret it. Say a Dr. orders a med and writes a med the patient can take q 6 hours but adds "please do not give more than 3 times in 24 hours." I was taking to mean if a patient comes up at 1pm today and requests the med, I look back 24 hours from 1 pm today to 1pm yesterday and see how many doses they got from that viewpoint. Another nurse said no, you it just means that they can only get it three times in the 24 hour period of 0000-2359. And our electronic record, we have a tab that for each med will pull up a little individual section that show's that med's administration from 0000-2359. She says what I am doing is overthinking, and all I need to do it pull up that tab.

It actually can make a different on which way you look at it. For instance, if yesterday they got the med @ 9am, 5pm, and 1130 pm...then they come up today and want it at 8am -->my coworker would say it's ok to give because it would be their first of three doses in today's 24 hour period, where the way I was looking at it, they would have to wait until after 9am today to get a dose or else it would be >3 doses from 8am today (the time they are requesting the med) back through 8am the previous day.

Which is correct? It seems easier and kind of makes more sense to do it her way now that I look at it, but I'm just not sure. In the grand scheme it doesnt seem like a huge deal to be but just for discussion sake, how would you interpret?

Thanks!

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Specializes in Acute Care, Rehab, Palliative.

If they asked for it at 8 Am I would give it as their first dose for that day.

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Specializes in Critical Care.

Usually the best way to determine this is to ask the person who wrote it, but just based on how the order is written you wouldn't be able to use midnight-to-midnight as the timeframe in which you can't exceed 3 doses. If the order said not to exceed 3 doses per day then the argument could be made that maybe the Doc meant per calender day, but not when it says "24 hours". 24 hours is 24 hours, so if the patient got doses at 2200, 1600, and 1000 you couldn't give a dose at 0400 since that would be the 4th dose of the last 24 hours.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

If they are only allowed 3 doses per day why order it Q6 which is 4 per 24? I'd call the MD and clarify

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

^^Exactly. It's a poorly written order. The MD should rewrite it q8h.

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Specializes in Pedi.
If they are only allowed 3 doses per day why order it Q6 which is 4 per 24? I'd call the MD and clarify

Precisely. The order should be Q8h if the MD doesn't want more than 3 doses in 24 hours. Because if you give it q 6hr x 3 doses (say at 0800, 1400 and 2000) the patient will have to go 12 hrs without it through the night since he's had his 3 doses in 24 hours. Whereas if the order was appropriately written as Q8H, he'd get it at 0800, 1600 and midnight.

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Specializes in Pedi.

Also, this is the second thread you've started about maximum doses not matching with the ordered frequency of PRNs. It sounds like the pharmacy in your facility needs to start rejecting MD orders that don't make sense. This kind of thing would not have gotten by the pharmacy when I worked in the hospital.

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Specializes in Neuro, Telemetry.

I am just a student, but what we are taught is that "per day" is midnight to midnight, and "per 24 hrs" is 24 hours from whatever time it currently is.

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Specializes in Med/Surg, Academics.

Agree with the order is written poorly, and I also agree that a "24 hour" order as opposed to a "per day" order means it is a rolling 24 hours.

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Specializes in Hospice.
If they are only allowed 3 doses per day why order it Q6 which is 4 per 24? I'd call the MD and clarify

I see such orders quite frequently ... basically, if the patient needs more than 3 doses in a 24 hr period, s/he should be re-evaluated by the practitioner. The Q6hr has no bearing on that.

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Specializes in Hospice.
^^Exactly. It's a poorly written order. The MD should rewrite it q8h.

If they are only allowed 3 doses per day why order it Q6 which is 4 per 24? I'd call the MD and clarify

Precisely. The order should be Q8h if the MD doesn't want more than 3 doses in 24 hours. Because if you give it q 6hr x 3 doses (say at 0800, 1400 and 2000) the patient will have to go 12 hrs without it through the night since he's had his 3 doses in 24 hours. Whereas if the order was appropriately written as Q8H, he'd get it at 0800, 1600 and midnight.

I disagree. I've seen such orders - they are generally intended to manage periodic acute spikes in anxiety or agitation. Sometimes, a single dose of ativan has minimal to no effect and waiting another 8 hours to dose someone having acute anxiety or severe agitation is worse than futile. In fact, I think a q6hr interval is pushing it a bit. It's a bit like titrating to effect. Timely repeat dosing can get symptoms under control without snowing the patient. There might also be some concern for setting limits on a pt's tendancy to over-use the medication, while still treating the symptom.

An analogy might be the way I've seen some prescribe nitro for chest pain: 0.4mg sl, may repeat q5minutes x 2 (total of three doses).

Personally, I would look back 24hrs from the time of the request. But I agree that it can be confusing and that the practitioner needs to clarify

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