Ambien order did I make a mistake

loriangel14, RN · Dec 3, 2012

I would think if it means may repeat it would be two tabs again. I have never seen "mr" as an abbreviation.

Editorial Team / Admin · Dec 3, 2012

If mr is not an approved abbreviation, the order should have been clarified. Also, redoses may be limited by facility policy. Where I work, patients over 80kg have preoperative cefazolin orders automatically adjusted to 2g. However, if we redose the cefazolin in the OR because it's a long procedure, we are only allowed to redose with 1g, even though the patient's weight qualified for 2g. This means if the physician orders a 2g redose, pharmacy automatically changes it to 1g without having to call for clarification. If this is the case for your facility with regards to Ambien, pharmacy should be able to help you find the answer.

turnforthenurse, MSN, NP · Dec 3, 2012

I would have called the prescriber to clarify. And I have never seen the abbreviation mr. Also, the recommended daily dose of Ambien for adults is 10mg immediately before bedtime. So the original order calls for two 5mg tabs, but to repeat it if necessary results in overdosing the patient.

Esme12, ASN, BSN, RN · Dec 3, 2012

I've seen MR x 1 but it is not a clear order nor is it an approved abbreviation. Call for clarification.

brownbook · Dec 3, 2012

I read it as give the patient........ two...... five milligram Ambien tablets..... (total of 10 milligrams) at bedtime. MR (we use this abbreviation frequently) may repeat the order one time. So if after an hour the patient complains of not being able to sleep.....give the patient...... two....five milligram (total of 10 milligrams) Ambien tablets.

If the doctor wanted one tablet given as a "MR...may repeat" she would have....should have....written may repeat half the dose....or may repeat with one tablet.

I don't see it as confusing or being misinterpreted. I guess in the ideal world you would get a PDR or drug book and look up the recommended dose of ambien.....then call the Dr and say the drug book says that dose is too high.....then have the Dr reply....in a peeved tone......"No that dose is fine for Mr. Smith....please give it."

turnforthenurse, MSN, NP · Dec 3, 2012

I read it as give the patient........ two...... five milligram Ambien tablets..... (total of 10 milligrams) at bedtime. MR (we use this abbreviation frequently) may repeat the order one time. So if after an hour the patient complains of not being able to sleep.....give the patient...... two....five milligram (total of 10 milligrams) Ambien tablets.
If the doctor wanted one tablet given as a "MR...may repeat" she would have....should have....written may repeat half the dose....or may repeat with one tablet.
I don't see it as confusing or being misinterpreted. I guess in the ideal world you would get a PDR or drug book and look up the recommended dose of ambien.....then call the Dr and say the drug book says that dose is too high.....then have the Dr reply....in a peeved tone......"No that dose is fine for Mr. Smith....please give it."

It is still too high of a dose. if the MD states that is fine, OP, make sure you document that the physician was notified, they stated it was fine, etc etc etc.

nakinok · Dec 3, 2012

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.

Mommy&RN, BSN, RN · Dec 4, 2012

The max recommended dose is 10mg of IR Ambien. The CR Dosing is slightly different. So, I would clarify any dosage of 10mg.

Our docs will order 5mg may repeat x1

Esme12, ASN, BSN, RN · Dec 4, 2012

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.[/QUoTE]Why call your manager? What kind of unit are you working? The MD needs to clarify this order.
brownbook I don't see it as confusing or being misinterpreted. I guess in the ideal world you would get a PDR or drug book and look up the recommended dose of ambien.....then call the Dr and say the drug book says that dose is too high.....then have the Dr reply....in a peeved tone......"No that dose is fine for Mr. Smith....please give it."
A nurse...if he/she wishes to stay out of litigation and keep their jobs (and licenses) should ALWAYS look up a drug and know that drug before giving it. I could careless if the Doctor has a peeved tone....that's what they make the bucks for....if they don't want to be bothered then write the order correctly in the first place.

Meriwhen, ASN, BSN, MSN, RN · Dec 4, 2012

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.

eatmysoxRN, ASN, RN · Dec 4, 2012

Eek. Ambien is evil. Crazy stuff that drug causes. But I would interpret that order to mean 2 5 mg tabs * 2 if necessary.