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Discussion

ED protocols that include zofran?

Does anyone have standing orders/protocols for nausea and vomiting that includes giving zofran ODT? Our ED has been swamped with nausea/vomiting patients; and I didn't know if there was anyone out there with standing orders which include giving zofran ODT prior to the patient seeing the doc. I feel so bad for the patients that are actively vomiting when our ED is completely backed up, because they have to wait longer. This would be for healthy 15-40 year olds, with main c/o nausea/vomiting (for those patients that most likely have gastroenteritis).

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We don't. Partly because it is apparently quite expensive. The only standing orders in our ER are for tylenol or motrin.

We don't. Partly because it is apparently quite expensive. The only standing orders in our ER are for tylenol or motrin.

Zofran prices have come down, because it was a drug we could only give once and then go to phenegran.

We do give it prior to MD visit. Especially if they are waiting longer after triage, we don't need them vomiting all over the lobby and spreading whatever nasty they have, plus it helps with our over all scores when they get their survey :D.

No we dont have anything to give as far as that goes. On that note there are times I dont feel to sorry for them as more often than not you tell them to not eat or drink anything else. What happens when you reassess them later their sitting there still vomiting but they have a bag of chips, a soda or McDonalds; well of course your going to still be vomiting dummy.

Rj

Zofran prices have come down, because it was a drug we could only give once and then go to phenegran.

Not that much when we get calls from pharmacy's almost daily that a pt cannot afford the RX for 8 tabs at $125+.

Rj

  • Author

Depending on how your facility charges, ondansetron ODT (generic) breaks down to roughly $20 $25 bucks a pill. I'm sure that is cheaper than the charge for placing an IV and getting reglan or phenergan, since some facilities charge for not just the IV med, but charge for the nurse pushing the med. Just thought it would speed things up - having the patient feeling better before they are even seen and sent home with a script for reglan (or zofran if their insurance covers it), rather than waiting for fluids to go in, dealing with reglan reactions, etc. Plus, not needing an IV means no infection at the IV catheter site.

We've had a really nasty bug plaguing all area hospitals, and even staff are getting ill. I was persistently vomiting at home, so I called my doc and she phoned in zofran for me. Snce its generic, I paid $10 for 12 pills (wow, would've cost $200). My hubby went to pick it up at the pharmacy, and let me tell you - waiting that 30 minutes for him to come home was absolute hell. So I sympahize with patients who are waiting for quite some time to be seen. And let me tell you, zofran works BEAUTIFULLY, and it totally kicked my nausea/vomiting. They should put this stuff in the water!:yeah:

  • Author

Oh yeah, one dose of zofran 4mg ODT is safe for men, women, patients with liver disease, and patients with renal failure. Same dose for all, no adjusting needed (peds dosing is different obviously).

I have gone into the back for a verbal order for it before but we do not have a standing order...would be nice though.

We dont either, the only thing we have an order for is Phenergan or Compazine-PR or IM.

We don't have a protocol, but as soon as we get the patient in the back & get a line started, we'll often give Zofran IV prior to the patient seeing the doc.

It's been the same here - hundreds of young healthy adults coming to the ER for vomiting x 1-2 days. People have absolutely no tolerance for short-term illness. :banghead:

The only potential problem I see with this idea is that the patient's symptoms will be resolved with the ODT zofran and then they will leave without being seen by a doc or PA. It only takes one person to do this, go home and die of sepsis from a burst appendix before the media and lawyers start accusing triage nurses of practicing medicine without a license. :uhoh3: (Even if the person left on their own - it doesn't matter).

Blee

We have a list of protocols that are initiated prior to the MD seeing the patient. If the patient is in an ER room, on abd pain/n/v, we start an IV and give Zofran 4 mg IV x 1 dose, and phlebotomy draws labs. If they are in the waiting room, we just draw the labs and give the Zofran IV when they get to the back....can't have a bunch of people LWBS with IV's in!

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