How would you interpet this order?

[dudette10, MSN, RN]

Let's say you have a rather innocuous medication, like milk of mag indicated for indigestion. The order is written as:

milk of magnesia 15 ml 2 x per day PRN.

Would you interpret it as:

Patient is given it at 0900 w/ relief, then is given it at 1700 w/ relief and the nurse informs the patient that he can't have it again until after midnight.

OR

Patient is given it at 0900 w/ relief, expresses indigestion again after dinner and the nurse informs the patient that he can't have it again until 2100.

[akulahawkRN, ADN, RN, EMT-P]

Not well written, IMHO. Could be seen as "milk of magnesia, 15 ml 2 x, per day, PRN" or it could be seen as "milk of magnesia, 15 ml, 2 x per day, PRN.

I just don't see that order written specifically as q 12 hours. It probably is written to allow 2 doses of 15 mL of MOM every day, as needed, at the nurse's discretion of the specific timing.

[tbaughm]

It really has to do with the hospital interpretation of the order, but if the practitioner really wants it to be every 12 hours then he/she should write q12h.

[akulahawkRN, ADN, RN, EMT-P]

It really has to do with the hospital interpretation of the order, but if the practitioner really wants it to be every 12 hours then he/she should write q12h.

Exactly.

[RyanCarolinaBoy, ADN, BSN, MSN]

If it is not clearly stated as Q 12 hours, then that 2x day could be 5 minutes apart for all I care. If the Md wants to get specific, then it should state q 12 hours, otherwise it's up to the nurses professional judegement. Spliting hairs over something this ridiculous is one of my frustrations with nursing. Just use common sense and go on about your day!

[dudette10, MSN, RN]

For the record, I interpret it the first way.

[joanna73, BSN, RN]

Twice a day, dependent on patient status and the nurse's discretion, not q 12h. Otherwise, the practitioner should have indicated q12h.

[Been there,done that, ASN, RN]

The nurse needs to stop telling the patient "they can't have it" and get the order changed to obtain the maximum benefit for the patient.

[~PedsRN~, BSN, RN]

I'd give it twice with no regards to timing (because, it's MoM.. I mean, really) - and if that had no relief I would call the physician for a new order. Obviously order #1 = fail sauce.

[Girlafraid13]

I actually have a patient with a similar order. Polyeth glycol 1/2 cap "may give twice prn" usually AM nurse gives it with morning meds and holds if pt has diarrhea. And PM nurse only gives it if pt hasn't had a BM for more than 2 days. So that's pretty much like the first scenario.

[A.dela]

Simple, you call the ordering physician/PA/CNP and request they clarify

[BuckyBadgerRN, ASN, RN]

If it's been effective twice, why would the patient need it again? Just to play devil's advocate, or PITA =)