Dose calculations, new and old nurses.

Theone40 · Jun 27, 2015

10.3 ml ....

Jensmom7, BSN, RN · Jun 27, 2015

Do all nurses know how to do dose calculations? I learned them in nursing school, I was wondering if some old and new nurses are still shaky on them.
For instance, if the order reads "give 15 mg/kg liquid Tylenol PO" and the child weighs 22 kg, what is your dose? The Tylenol is 160 mg/5ml.
Would you be worried about a new nurse, off orientation, who didn't seem to understand how to calculate this, or would you just be happy that she came to you?

Both, actually. That's a pretty first level calculation. I did it in my head first, just to make sure the old neurons were firing,lol, then did it on paper. 10.3ml.

When I was precepting, I would make the orientee do the calculations long hand. They would grumble about calculators, but doing it long hand does a better job of hard wiring the process in the brain.

Also, I always encouraged them to have someone double check their calculations until they were comfortable. Off orientation or not, a new nurse is still being bombarded with a million different things. It was daunting when I started out 40 years ago, I can't imagine the stress now.

AJJKRN · Jun 27, 2015

Did they have a clue on how to calculate? I think some issues arise with having been taught multiple ways to get to the same answer during school. I get that we all learn differently but five different ways from really easy to ridiculously complicated can muddy the water that otherwise should be crystal clear! PS: I personally think we rely way too much on technology and wished I was taught how to start/maintain a gtt without a pump when I was in school. I was told I would never need to but life and nature happens...I'm not so sure either if my lab teachers remembered how to do it or if we just didn't have the supplies to learn even if they did!

brownbook · Jun 27, 2015

"Didn't seem to understand how to calculate this" is worrisome. It could be new nurse jitters, especially with a pediatric patient.

Maybe find a simple drug calculation work sheet for nurses and offer it to her for practice. Hopefully she can work out the problems correctly at home when there is no stress?

There have been so many problems with Children's Tylenol, different strengths, dosages, etc. But she should have an idea where to start with the calculations.

smf0903 · Jun 27, 2015

We had to learn how to start and maintain a gravity drip, it was a part of our IV check off. We were told that every nurse should know how to do it and that most places had gotten away from teaching students how to do it. We were told the eye opener was during Katrina when there were pumps unavailable and people didn't know how to start/maintain gravity drips (maybe an exaggeration, maybe flat out truth, I don't know...but we were taught!)

icuRNmaggie, BSN, RN · Jun 27, 2015

I was taught that all pediatric meds must be verified with another nurse and I have always done so, in PACU or any other setting. If the nurse could not do a simple calculation, then that is cause for concern.

Editorial Team / Admin · Jun 27, 2015

Would you be worried about a new nurse, off orientation, who didn't seem to understand how to calculate this, or would you just be happy that she came to you?

Both. Drug calculations are a must know, and reliance on technology is overused. As someone else mentioned, just look at what happened with hospitals right after Katrina. But I would be happy the new nurse came looking for help before possibly committing a med error.

Pediatric Critical Care Columnist · Jun 29, 2015

I have to say I do think a lot of the trouble comes from the way basic mathematics is taught in schools today. I've watched new nurses work out dose calculations on a paper towel and my mind boggled at all the extra steps they took. I once gave my two daughters who are now in their 30s and neither of them nurses some med calculations to see what they did with them. They both were able to figure the doses out in a matter of seconds using the same methods I use. On my unit we are required to have every med double-checked by someone else unless it has come prepared by pharmacy. Many errors are caught this way, but surprisingly there are a lot that aren't because both persons make the same error in calculation. How difficult can it be? Dose desired divided by concentration available. Simple algebra.