How do you chart this without it looking like you are giving a med early??


Ok. I am in a small rural hospital. Our OBs/Midwives have a check list of medications they want the patient to have. Then when we note orders we have to transfer them onto a pre-printed med sheet and write any in that are not on the medsheet. Most of the Narcotics are written on the Doctors forms like " Vicodin 1 or 2 every three hours for moderate pain"...but when we write them on the med sheet there are two different boxes for the Vicodin, one that says Vicodin 1 every three hours as needed and Vicodin two every three hours as since they check OR on the doctors orders we open up both meds on the med sheet. I was told that since the doctor order says "One or two every three hours" we can give one now and then if they still have no pain relief in say 45 mins we can give another because it is still under the order of 1 or 2...but how do you chart this on the med sheet when I sign that I gave them ONE under the "Vicodin one every three hours as needed..." when I give ONE more an hour later and chart it in the ONE every three hours because I am only giving one? looks like I am giving it two hours early but in fact I gave them one now and one a little later for a order that says 1 or my question to confusing? If not can you answer?

Indy, LPN, LVN

1,444 Posts

Specializes in ICU, telemetry, LTAC. Has 5 years experience.

If your MAR is paper, write the actual order in under the part where it says "two every three hours" - write "order states 1-2 every 3 hrs". Ok then if you give one, under that same box, write the time, next to it write "1 tab" and your initials. Then should you give another, write it the same way.

Facilities differ on whether they like to allow ranged orders and the pharmacy is trying to make it make sense, I think. But anyhow that is how I would do it. What really is bad, is when the order states something like 1-2 tabs every 4-6 hours. That's too much room for complication, both in dose and time there.


660 Posts

Specializes in ER. Has 3 years experience.

The facility I work at discourages this. Say you give 1 Vicodin at 1300, the give one more at 1400. Do you give the next dose at 1600 or 1700? Do you give 1 tab or 2 tabs for it? This is why I either give 1 tab or 2 tabs and not divide the dose. I would be careful of this practice and consult your nurse manager for clarification.

Has 16 years experience.

i would consult with two people in this case. one is your supervisor, and the other is the pharmacy. remember you not only need to follow docs orders, but also facility policy and the pharm should have it down pad. sometimes if i see an order like that i would also question and add to the order "may give 2nd tab if no relief in 1 hour." i would also add that statement if pt has scheduled vicodin.

i had this dilemma once with dilaudid 8mg sc schedule q 6 hours with a prn dilaudid 16mg for breakthrough q 12 hours, my eyes frogged out..... r/t sickle cell anemia

leslie :-D

11,191 Posts

when i add the 2nd dose/tab of a single order, i write down the date, the time and write. "second tab of vicodin given r/t unrelieved pain".

never been an issue.

i must not be understanding op's question?

as long as you note the date and time, it would seem pretty apparent what and why, was being given.


wooh, BSN, RN

1 Article; 4,383 Posts

Just give them 2 in the first place to avoid the problem. :)

Agree with Leslie. The order is there. Chart why you gave a second one. It doesn't matter how it "looks" on the MAR as long as you (and whoever follows behind you) can find in the chart why and when you gave what.

Specializes in Emergency, Case Management, Informatics. Has 13 years experience.

At the facilities I've worked at, it's not acceptable to give an "add-on" dose. If the order is 1 or 2 Q 3 hours, then it's either 1 every 3 hours or 2 every 3 hours.

If your facility does allow you to interpret the order in the way that you described, I would just write in the nurse's notes that you are giving a second Vicodin for unrelieved pain, noting that the order is for 1 or 2 Q3 hours. The MAR is not the end-all, be-all of med documentation. ;)