Confusing Order

[chiari_mom]

ORDER READS:

Haloperidol (Haldol 5m/ml) 0.5-1.0 mg subcut TID routinely AND 1-2mg subcut TID PRN for nausea, vomiting, or delirium.

TID = every 8 hours (three times in 24 hours)

What would you consider the maximum dose that is permitted EVERY EIGHT HOURS?

[leslie :-D]

I have never given Haldol for nausea or vomiting.

from medscape:

"Unlabeled Uses: Cancer Chemotherapy-Induced Nausea and Vomiting, ..."

http://www.medscape.com/druginfo/dosage?drugid=14677&drugname=Haldol+Inj&monotype=default

leslie

[LadyTiger44]

Ditto, 3 mg max in 24 hrs, also ditto, never have seen it for n/v?? I would question the doc.What is the rationale for TID,ATC agitation/delirium ? Why sq,if po or IV not possible there is always conc solution/elixir gtts?

Remember guys JULY is just about here, pray for all of us in the teaching hospitals with all the inept newbies starting:eek:

I think she was talking about the new resident drs. I work in a teaching hospital and have been told this over and over--but this is my question.

How do I know if it is a new resident? Look at the orders and see if they are whack?? I am new and don't know the docs very well, and its almost July

[ebear, BSN, RN]

Yes, Grumpy, I am talking about the new RESIDENTS too! They'll be the ones who look "lost" and write PAGES of weird orders...then come back and change them all again in an hour. In the O.R., they'll be the ones who contaminate everything and take 5 hrs to do a hernia repair (bless their hearts) In the ER...I can't eeeven go there (!) It's strange too, that just couple of years later they think they know EVERYTHING and often talk "down" to the nurses. You know, the nurses who helped them keep their tails out of a crack just a couple of years before.:stone

[litbitblack, ASN, RN]

we usually have good residents. They ask and use our advice and do not talk down to us. I just hate having to learn new names I can't pronounce lol

[EarthChild1130]

Haldol is, as far as I know, only approved for IM injection...it is used for IV injection even though it's not officially 'approved' but should not be used subcutaneously to my knowledge...

Maybe the doc could change the route to IV instead of injecting it? Or perhaps ask the doc if he can try a med with less side effect potential??

That's DEFINITELY an order that needs some clarification!

[Babs0512]

ORDER READS:

Haloperidol (Haldol 5m/ml) 0.5-1.0 mg subcut TID routinely AND 1-2mg subcut TID PRN for nausea, vomiting, or delirium.

TID = every 8 hours (three times in 24 hours)

What would you consider the maximum dose that is permitted EVERY EIGHT HOURS?

I come up with 3mg, you can always clarify the order and specifically ask for a maximum daily dosage. Never having worked in Psyc (never heard of Haldol being used for N/V) I'm not sure how you decide whether to give 1-2mg - nursing judgement? Delirium worse than night before? One episode of vomiting or two.

This is a confusing order, too many back doors for something to sneak in and bite you in the orifice.

[BradleyRN]

I dont like this order at all. If the pt is already on routine haldol for some kind of psychosis, then why use it for n/v as well? Are we trying to cause potentially permanent EPS symptoms such as tardive dyskinesia or dystonia? State funded psych facilities use haldol because it is much cheaper than alternatives. I would request something else. 3mg q8h may be less than what could have been prescribed, but i would feel it to be within my boundaries to refuse to give extra haldol for n/v!

[GrumpyRN63, ADN, RN]

i think she was talking about the new resident drs. i work in a teaching hospital and have been told this over and over--but this is my question.

how do i know if it is a new resident? look at the orders and see if they are whack?? i am new and don't know the docs very well, and its almost july

ladytiger, here's where us old "nurses past their prime" will come in handy:chuckle ,( oh yeah, that's another thread) yeah, you're going to see obvious orders, and then questionable orders that your just not quite so sure about, hopefully, you work among a number of nurses and you will be able to pow wow with them among what may seem off, also if you think its wrong you can go up the chain to the junior or senior resident. keep on your toes, you'll be fine, july comes every year !!!