Anything wrong with this order?

i don't like that order. it is written poorly. it can create confusion. what's up with the daily then 10am and 6pm? daily means once a day.

it should be written as lactobacillus 1 packet po (or gtube) bid at 10am and 6pm.

or lactobacillus 2 packets po bid at 10am and 6pm.

wow. i don't know how much i would have given. i would probably call the doctor and get it clarified.

do you need the permission of the supervisor before calling the doctor? if not, i would just call the md anyway even though the supervisor said the order is okay.

^^^What he said.

I think some nurse added the times. The order doesn't have a time on it.

It reads: Lactobacillus

Dose: 2 packets

Frequency: Daily,in divided doses throughout day

i think some nurse added the times. the order doesn't have a time on it.

it reads: lactobacillus

dose: 2 packets

frequency: daily,in divided doses throughout day

still a bad order. daily means once a day and should not be divided. the md should clarify the frequency. does he want it bid, tid, or qid? i would still call the md and get it clarified.

I think some nurse added the times. The order doesn't have a time on it.

It reads: Lactobacillus

Dose: 2 packets

Frequency: Daily,in divided doses throughout day

Oh, well if that is the case, I would clarify first prior to administration. It is way too vague. The way it is written, you could potentially give it 4 times a day. No route is given, although it is assumed that it is PO...but it should be WRITTEN.

Call MD for clarification at 3AM. Write some of the new cursing words you've never heard before down and share with us.

Break the dose down on 4 parts, for each meal and night snack. Give it before the food. That's based on the drug administration guidelines.

The order is written poorly, but nursing judgement is good enough to make sense out of it.

Call MD for clarification at 3AM. Write some of the new cursing words you've never heard before down and share with us.

Break the dose down on 4 parts, for each meal and night snack. Give it before the food. That's based on the drug administration guidelines.

The order is written poorly, but nursing judgement is good enough to make sense out of it.

Huh? I don't get it.

Huh? I don't get it.

Sure, it can be made sense if, by an intelligent nurse. But an order should never be subject to interpretation. It should be clear.

If everyone does it however they please, imagine what the patient's perception is: "yesterday the nurse gave it to me three times. Why are you giving it to me twice?" what's an acceptable answer to that? There is none!

It sounds like the doc just opened up the PDR and copied it verbatim (although o know this drug is not listed in davis' drug guide, as all of my student come to me in a panic when they have to give it :) ).

Sure, it can be made sense if, by an intelligent nurse. But an order should never be subject to interpretation. It should be clear.

If everyone does it however they please, imagine what the patient's perception is: "yesterday the nurse gave it to me three times. Why are you giving it to me twice?" what's an acceptable answer to that? There is none!

It sounds like the doc just opened up the PDR and copied it verbatim (although o know this drug is not listed in davis' drug guide, as all of my student come to me in a panic when they have to give it :) ).

I was talking about the post itself. We who are the regular nurses give it bid. Its when prn nurses come that the med errors occur.

I was talking about the post itself. We who are the regular nurses give it bid. Its when prn nurses come that the med errors occur.

Lactobacillus is usually given before meals. Med errors occur when we give something we don't know is for and don't care to double check with available pharm. resources, or when we relax and lose focus, because "we've given it so many times". PRN vs. FT has nothing to do with this.

Sure, it can be made sense if, by an intelligent nurse. But an order should never be subject to interpretation. It should be clear.

Divided doses? Is that q1h, q2h, q3h....?

Some of the folks I work with would set up 12 medicine cups and divide one of the packets into the twelve cups and be running in there all night, rather than call one of the docs who likes to yell at folks. Makes him feel special, I guess.

I saw that the supervisor won't call. Personally, I don't like the "charge nurse has to decide to call the doc" attitude at some places; sometimes, you disagree with the charge, or worse, you've got one that's so worried about "bothering" the doc that she doesn't look after the patient.

I'd try to bring it up again, using the angle that the patient may be getting too much or not enough (one shift gives one packet, the next gives 2, and you really don't know if the doc wanted 2 packets or 4 packets per day).