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

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.

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.

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

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.

leslie

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.

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.