Ambien order did I make a mistake

nurseprnRN, 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.

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.

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

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.

CapeCodMermaid, RN · Dec 5, 2012

If all you have on hand is 10s, you can't give a 5.

Meriwhen, ASN, BSN, MSN, RN · Dec 5, 2012

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.

Guest343211 · Dec 5, 2012

Get the rx clarified, rewrite, and be done wih it. Doesn't get easier than that.:)

MunoRN, RN · Dec 5, 2012

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.

BrandonLPN, LPN · Dec 5, 2012

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.

BrandonLPN, LPN · Dec 5, 2012

As for the "may repeat" bit, wouldn't it make most sense transcribe that in a separate box on the MAR as a PRN?

CrystalSSA · Dec 5, 2012

I would call to clarify because 4 ambien is a heck of a big dose. I rarely see two given.

Guest343211 · Dec 5, 2012

The order doesn't meet the safety guidelines. Even if you repeat 10mg x 1 nothing will in all probability happen to the patient--but you never know. What if they climb out of bed, tear out their lines, fall, whatever. The first person they look to for assigning blame is the nurse.

So, if it is dubious in any way, which it is, just get the darn thing clarified as per the safety standards. Sometimes you have nudge a newer doc along in this regard. You speak it back to them and ask if that is what they want, or you say, do you want the 5mgs or the 10 mgs repeated * 1? I have simply re-stated the rx by what is acceptable and protocol, and they would be like, "Yea. That." No if it is outside the protocol, and there is a good reason for it--like this is what the patient usually does at home, or whatever, fine. Write and Read the exact order back, get affirmation from them, and observe and document how the patient tolerates it.

This is a lesson to teach you that you have to get things covered correctly; b/c the next time it could be a medicine that could do major damage if transcribed or followed incorrectly.

You can also say, "I see that the usual dose is blah, blah, blah. Is that what you want or something different?" Always carry a software program or have access to pharmaceutical substances you will administer--and also refer to the hospital or institution's formulary. Clarifying with a doc goes so much better, as well, when you address something intelligently and without an attitude of either timidity or arrogance. No extremes.

Cover yourself, and get a correct order for everything. And I say this, and I have worked in critical care units where we were given a ton of autonomy compared with the floors--and a tons of autonomy especially compared with pediatrics or PICU or NICU (You kind of give up the same kind of autonomy to work in those areas, b/c there is less tolerance for error.).

At the end of the day, however, EVERYTHING NEEDS A CORRECT ORDER. You will be called on the carpet over it. So, if you take off the order, or you go to follow it, but you do not make sure it is a correct/acceptable order--or that it is at least clarified and noted as such, it will fall back on you.

Thous shalt cover thine orifice.

Guest343211 · Dec 5, 2012

I would call to clarify because 4 ambien is a heck of a big dose. I rarely see two given.

I know one thing, Ambien sure made me do some crazy things. Just ask my kids. I stopped taking it. I was afraid I'd end up driving around the neighborhood naked. So I don't touch the stuff. :)