giving smaller dose med?

[pblpn]

Hi, this is my first post, I'm a new grad lpn but came up with a question I can't seem to find.

If you have a prescribed dose of a med for a pt, ex: Metformin 1000 mg po daily, and you work at a place where pharmacy is not 24 hrs/isnt open at that time for whatever reason. Doc orders by phone to have Rx changed to Metformin 500 mg while pharmacy is closed and you have to give patient medication. Would it be ok to cut the pill in half or do you have to wait until pharmacy sends you 500 mg? Would I waste the rest?

Its like 3:00am in the morning now and I woke up with this question...lol....yes I'm stressed about taking the boards.

I dont know what I would do about a situation like that above. Any advice? TIA!

[TheCommuter, BSN, RN]

If the 1000mg tablets are scored, it is acceptable to break it in half and administer one-half of a pill to the patient so that they receive the 500mg that is ordered. However, my state requires that in settings such as long term care (where on-site pharmacies do not exist), you must also obtain an order that states, "May give half of one 1000mg tablet to equal 500mg."

[Meriwhen, ASN, BSN, MSN, RN]

Also (depending on your facility policy and state laws), you could probably save the second half of the pill for the next dose.

[pers]

Our pharmacy is always open but we routinely cut pills in half because we don't carry (or currently have) the correct dosage pill. Oddly enough though, if I have an order for a 500 ml NS bolus, I have to use a 500 ml bag. I can't use half of a 1000 ml bag or two 250 ml bags!

There's really not a hard and fast rule to answer your question other than that it depends on the policy of your facility (which should be based on the laws in your state).

[silverbat]

i am confused.....

the order stated 1000mg,(and you are concerned about cutting it in half) you must have a 1000mg, so why whould you call to get the order changed if you had what was ordered? If the order was recieved during the week will the meds get there that evening or early the next day? In these situations, no other order needs to be recieved, because meds are there or will be by the next dose. If it is the weekend and it WILL be two days before then meds are recieved, then I could see getting the order changed, then follow policy on cutting if pills are scored.

[classicdame, MSN, EdD]

I think the concerns have to do with unit dosing requirements. After all, cutting a tablet does not quarantee correct dose. And there may be an issue with charging the patient, as well as wasting. So best to follow facility policy. I would cut it.

[LesMonsterRN, ADN, RN]

i am confused.....

the order stated 1000mg,(and you are concerned about cutting it in half) you must have a 1000mg, so why whould you call to get the order changed if you had what was ordered? If the order was recieved during the week will the meds get there that evening or early the next day? In these situations, no other order needs to be recieved, because meds are there or will be by the next dose. If it is the weekend and it WILL be two days before then meds are recieved, then I could see getting the order changed, then follow policy on cutting if pills are scored.

This is how I originally read the op. What I understand now is that the patient originally had an order for 1000mg and the doc changed the order to 500 but pharmacy was closed at the time.

I would halve the tablet if scored but only until pharmacy was able to supply with the correct dosage.

[LouisVRN, RN]

I agree it would in my facility be permissable to give the patient half of the 1000mg tablet if scored (although now all meds are cut by pharmacy) however if we cut it in on the floor we have to waste the second half. Seems like a waste imo.