Administer medication right or wrong

[Lovenursing1116]

Question:

When administering a medication according to Mar. For example if you need to administer a quarter of a pill should the Mar read. Give 0.25mg or 0.5mg of pill and should the mar have the Dose of the medication you're getting the quarter from.

Which is right or are both of them wrong?

Ativan 2mg

Give 0.5 mg PO bid.

Ativan

Give 0.5mg PO BID.

I was told that you give whatever is on hand.

Now minding you, you just need to give a quater.

I know with nursing you should know how to break a pill and dose it correctly. But is this right or should it be wrote out differently.. Please help!!

[heron, ASN, RN]

In my facility, it would be written:

Ativan 2mg tab, give 1/4 tab (0.5 mg) po BID

[Lovenursing1116]

Thank you!! So how do you write a quater on the Mar. I see where I went wrong now.. So if the Mar read Ativan 2mg give 0.5mg PO BID then I would know to give a quarter. Which is 0.5mg X 4 = 2mg

Now when I read the Mar it said Ativan give 0.5mg PO bid.

In other words if I'm using what's on hand shouldn't the MAR tell me which dose to take 0.5mg away from with the correct time.

[Lovenursing1116]

I feel like I'm just over thinking because when I was told to give the med. I was told to give it 4 times s day and to give it at 10 pm but in the Mar it said it was to be given BID first dose at 7pm

[heron, ASN, RN]

Thank you!! So how do you write a quater on the Mar. I see where I went wrong now.. So if the Mar read Ativan 2mg give 0.5mg PO BID then I would know to give a quarter. Which is 0.5mg X 4 = 2mg

Now when I read the Mar it said Ativan give 0.5mg PO bid.

In other words if I'm using what's on hand shouldn't the MAR tell me which dose to take 0.5mg away from with the correct time.

You would write "1/4" or "one quarter". The point being that the MAR must specify the med supplied by the pharmacy and how much of it to give. What does your facility policy or pharmacy have to say about it? Or am i doing your homework?

[heron, ASN, RN]

I feel like I'm just over thinking because when I was told to give the med. I was told to give it 4 times s day and to give it at 10 pm but in the Mar it said it was to be given BID first dose at 7pm

This makes no sense. You give what's written in the orders. If the person telling you different is the prescribing provider, then you need to enter it in the chart as a verbal order (if permittedby your facility). If you were told this by any other person, a clarifying call to the prescriber is called for.

[heron, ASN, RN]

These questions really need to be addressed with your pharmacy or in your facility policies.

[JKL33]

For example if you need to administer a quarter of a pill should the Mar read. Give 0.25mg or 0.5mg of pill and should the mar have the Dose of the medication you're getting the quarter from.

Well, aside from everything else, if you are supposed to give 0.5 mg then no, clearly it cannot say give 0.25 mg of a tablet, regardless what is "on hand."

This is all very simple when focusing on the units of measurement.

In the past I have seen some orders that are indeed ambiguous, such as:

"Ativan 0.5 mg (½ tab) po @ hs" (Give half tab of 0.5 mg, or 0.5 mg is a half a tab?) **

So yes, it is important that the order includes the name of the med in the doseage supplied.

But your original question seems to have arisen from mixing mg with "portion of tablet."

**By the way, many patient-written med lists brought from home make this error and it is very important to ask them what they mean by that. They take 25 mg of X, and then they also write "½ tab" - - but what they mean by that is that they know they actually have 50 mg tablets at home and they take 25 mg, and they write in the extra "reminder" for themselves that 25 mg is going to be half a tab.

So their med list looks like this:

X med - 25 mg (½ tab) - am and pm.

[Lovenursing1116]

Ok thank you..

[Lovenursing1116]

I work at a home health and the parent told me to give a quarter of a 2mg medication. So before I gave the med I checked the MAR and there was no such order. So I didn't give the medication to protect myself. The order is now clarified. Thanks for responding!

[NurseSpeedy, ADN, LPN, RN]

I work at a home health and the parent told me to give a quarter of a 2mg medication. So before I gave the med I checked the MAR and there was no such order. So I didn't give the medication to protect myself. The order is now clarified. Thanks for responding!

This is a common problem in home health pediatric nursing. You have specific orders that you have from the provider. These are what you can give. Anything different you need a clarification order for a different dose. If the parent wants to change the dose, then they will have to give it. I would also make a note of this to cover myself (and also work toward getting that order for them so they have it in the future).

As for the written dosage, it should show how much of a tablet and how many mg the dose is. Example Ativan 2mg tab: give 0.25 tab (0.5mg) Ativan via PEG every eight hours PRN agitation. Also, make sure what your companies policy is for pill cutting. About 18 months ago policy changed where I work that the smallest we could cut a tab was in half. Quarter tab doses weren't allowed there anymore.

[Kitiger, RN]

If a tablet is scored, then each side of the tablet has the same amount of medication in it. If the tablet is not scored - or if you are giving 1/4 of a tablet - the medication may not be evenly distributed within the half-tablet (that you need to split to get a quarter tablet). If you are giving the 1/4 tablet doses consecutively, it doesn't matter as much.