giving half a dose

Well said commuter!!!!

Some places have protocols for adjusting insulin. My current workplace specifies a half dose of some insulins for NPO patients, for example. At another place I worked, doses were commonly adjusted down (often at the patient's request and without an order). It may not have been legally correct, but it was the workplace culture and acceptable to the nursing supervisors as well as the rounding MDs. The dose actually given was always documented, of course. In some cases, an order was obtained after the fact (usually for future doses), but not in every case.

It's probably not something you want to continue to do, but your facility may or may not see it as significant.

need to discuss with doc.

"The commuter" said it well. Just to add to it, there are some facilities that have policies outlining very conservative DM management. The hospital I had my clinical rotation at would have insulin dosages rounded down depending on provider's order.

An order from physician must be obtained for any dosage adjustments at all times.

Deciding to administer half a dose is not within our scope of practice as nurses. Either you give what was ordered or you hold the dose entirely.

If you or the patient feel more comfortable giving half the dose, you must call the physician and allow him/her to make that clinical decision. If the physician approves the reduced dosage, you are now covered by a physician's order.

However, deciding to give only 10 units of Levemir when 20 units was ordered is basically practicing medicine without a license. You cannot make that judgment call on your own. Call the doctor next time you want to give half a dose.

Patients can play with their dosages at home, although they are not supposed to. However, nurses are held to a higher standard of care and can be subject to disciplinary action for fooling around with dosages that were not ordered.

I don't completely agree with this. With insulin its different but other meds, I don't see an issue giving a half dose.

Example: a patient c/o headache asks for tylenol. The doctor writes for 650mg tylenol PRN. You bring it to the patient and the patient says "I just want one tablet. If my headache gets worse I'll take the other one later." Honestly, I'd be completely okay with that, give them the tablet, and document in the MAR that pt wished to only have one tablet.

Would you really say to the patient that they have to take both or none at all? Or waste time calling the doctor and asking if its ok to give them just one tablet? Most doctors I know would laugh at you for doing that.