Do nurses do med math

[direw0lf, BSN]

A pharmacologist teaches our pharmacology class, and I asked her the other day "I know this is important, but I was told that nurses don't actually ever do dosage calculations in the real world nursing, is that true?" and she said yes, the pharm does that for you. I asked what about even checking to make sure an order is correct (because our nursing instructors warned us to always check if an order looks wrong) and she said the pharm always checks that too. But it made me wonder, why are there so many medication errors then? Do nurses do dosage calculations? Thanks.

[NurseGirl525, ASN, RN]

There are not a ton of medication errors. The media makes it seem that way. Ultimately, as the person administering the drug you are responsible. You do need to do med math. Maybe not the long way they have us do it, but you have to verify what you are giving is what they are receiving. That is part of the 6 rights of medication administration.

I check. Always. The pharmacist is human also. He or she can make a mistake. I don't want their mistake to kill a patient or fall on me as I am giving the med.

The nurse is the last line of defense. Physicians make mistakes too, and the pharmacy may not see it. It's up to me.

[direw0lf, BSN]

Thanks, Heather. My instructors make it seem that way too (that there are many medication errors) they said it's the number 1 cause of hospital deaths.

I think I just get frustrated and know you're right, I just have such a mental block with these dosage questions. I think I need to just do them repetitiously and it'll get easier.

[nursej22, MSN, RN]

Um, pharmacists can make errors, too.

[LadyFree28, BSN, LPN, RN]

Um, pharmacists can make errors, too.

This...

A pt received TEN times the dose of a medication; it was an obscure med, one that hasn't been used, but the pharmacy made the error...

I used med math everyday; I've had to double check a resident giving 1.5 times the dose-although it was verified by pharmacy, the pt would've had complications-it was a sedation medication (Versed).

[RainMom]

If you have an eMAR & scan meds, pharmacy has done the math. But as mentioned above, they aren't perfect either; pay attention, especially when you only need half tablets...don't forget to cut them. In an emergent situation, you can't wait for pharmacy verification...do the math & give the dose.

Some depts may not fully use EMR. For instance at my facility in pre-op & PACU, we don't scan meds & orders are marked on pre-printed order sheets. Meds do not get verified by pharmacy at all with the exception of the pre-op antibiotic. Most med math is pretty simple but in some instances (like calculating a wt based peds dose), I grab another nurse to double check with me. We also rarely use pumps, so have to actually figure drip rates.

So, I guess what I'm saying is, yes, pharmacy does the math in most instances but you can't blindly follow it without thinking about it. And there will be times where you have to do the math yourself.

[KelRN215, BSN, RN]

Even if you use eMAR and scan meds you still do med math. What about when you're administering controlled substances from the pyxis? You need to figure out how much to draw up when you need to give 1.5 mg of ativan and you have a 2 mg/mL vial.

[JBudd, MSN]

Nosocomial infections, not med errors, kill more patients than die in car accidents in the US every year.

But yes, we do drug calculations all the time, because not everything comes in a nicely packaged unit dose. Not to mention titrated drips. I like dimensional analysis the best, get all the labels in the right place in the equation, they cancel out and you know you've got the right answer.

[Rose_Queen, BSN, MSN, RN]

Not only do I do med math, I actually mix a lot of my own meds. That's what happens when you work in the OR and have surgeons with interesting mixes. We have one guy who likes his local mixed with bicarb and saline. Guess what? I'm the one who has to calculate out how many mLs of what gets mixed together to get the amount he wants available.

[HopefulRN7]

I'm a Pediatric nurse and we live and die by being able to calculate dosages, often changing being that many are based on current wt. I've been in the Peds setting for only a year now and have seen more med errors in this setting than others.

Doctors prescribe dosages outside therapeutic ranges and pharmacists label dosages incorrectly.

You are ultimately responsible once you administer the med so know how to calculate and have a reference manual (or app) available on your shift

[Nonyvole, BSN, RN]

I have to use med math very regularly in the ED...

[momof3lv]

I did a lot of med math as a peds nurse. You are always calculating for weight in kg. As an adult nurse now, not so much but I still do it occasionally. I think it comes easier to me then some nurses who have always worked adults do to my peds experience.