Help with this doctors order....

tvccrn, ASN, RN · Mar 21, 2008

Maybe the point they are getting at is that the gr is an unapproved abbreviation that could be either grains or grams?

YellowFinchFan · Mar 21, 2008

How old was this DOCTOR? (old???)

Could you let the pharmacy sort it out?

That's why I LOVE computerized documentation and ordering, the DOCS must put their orders in the computer NO MORE trying to read their horrible handwriting.

thats progress!!!!

:nurse:

GrumpyRN63, ADN, RN · Mar 22, 2008

I always went with 1 grain = 65 mg, easiest way I remember it was Tylenol 650 mg= gr X, I would equate gr XX = 1300 mg, it doesn't need to be converted, the pharmacist should take care of that end and where I work, call the MD him/herself to clarify

TiredMD · Mar 22, 2008

A doctor who knows what a "grain" is? He must be in his 80's.

leslie :-D · Mar 22, 2008

ah yes, the apothecary system...

according to his order, it looks like he wanted anywhere from 1200-1300 mgs of the pheno...

an order i would have clarified, for more than 1 reason.

leslie

donsterRN, ASN, BSN · Mar 22, 2008

We're taught and tested on this stuff weekly! It seems like we're ALWAYS getting "gr" questions.

One grain (gr) is equal to 60 mg.

Gr XX is 20 grains, which equals 1200 mg. That dose is excessive for phenobarb, since (I think) capsules come in 15 mg dosages. Even if your capsules come in 200 mg form, you'd still have to give 6 of them to meet the doctors order. I'd certainly clarify what the doctor is ordering.

imanedrn · Mar 22, 2008

I would go back to the doctor to clarify the order, but I would think the gr=grain and XX=20 in roman numerals. There fore the order MIGHT be 20 grains.
Once again, please DON'T take my word for it. Clarify with the prescribing physician.

This is correct. gr (grains) are written in Roman numerals. I know we learned this in school, but I can't believe a doc is actually using these!

Other than clarifying the dose... you can have the pharmacy convert it for you and note that they did it. I've done that in the past to confirm my conversions.

sharann, BSN, RN · Mar 22, 2008

A doctor who knows what a "grain" is? He must be in his 80's.

:chuckle

That is what I was thinking. Honestly though, I was taught that orders such as

"grains","drams", and "ounces" are not to be used anymore. It seems ridiculous to use such an obsolete unit which is not metric anyhow.

I can foresee many mistakes from orders such as "phenobarb gr XX". Why not just do it right the first time and avoid the multiple phone hassles(for all of us!) later.

liebling5, MSN, RN · Mar 22, 2008

Tylenol and aspirin are occasionally ordered in grains. For example: Tylenol gr. X p.o. q 6h for pain/fever. Taking 65 mg per grain, that's 65 times 10 (the X)=650 mg. If the order is for phenobarb, a more realistic (and safe) dosage would be (in grains) 1/2 grain, which is 30 mg in this example. Hope that helps. :smokin:

ICRN2008, BSN, RN · Mar 22, 2008

I hate it when doctors order things in grains! It's utterly archaic!

Not to mention potentially inaccurate (and definitely confusing)!

I wonder when physicians will learn that if they write clear orders in the first place they will not get annoying phone calls or pages asking them to clarify.

Dolce, RN · Mar 22, 2008

What a confusing order! That one needs clarification before any medication is given.

As a side note about grains to mg....I always remember that a regular strength aspirin or tylenol tab is 5 grains. Therefore, 5 grains=325 mg. Therefore, 1 grain= ~65 mg.

katienj · Mar 22, 2008

the doctor gave me an order of Phenobarbital capsule gr XX .
what is gr XX? the bottle contains 200 mg per capsule.

It means grains 20. gr=grains and the XX=20 in Roman Numerals. That is the Apothecary system. Did you learn this in school? Doctors frequently order Tylenol or aspirin grains 10. Is this the first time you have seen this?