How about this for an order?

Nurses General Nursing

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This may just be my naivete or age showing but I saw a prn order from an old "breast man" that read verbatim "Ativan 1 mg p.o q 4-6hrs prn pain".

Yuck :uhoh3: :angryfire

Specializes in cardiac ICU.
Oh my gosh you guys! What I meant was this guy is one the the "older"(like 75)and more well known breast surgeons in our area. He is new to our hospital because another near us closed down(Again). I don't really know why some of you are so sensetive about the use of the term. His orders are PREPRINTED and he never changes them. I was told "he does not like narcotics". He only orders Ativan for PAIN and Tylenol extra strength, for post mastectectomy and lumpectomy pain.

Sheesh :chair:

He belives that women in pain are just hysterical because breast surgery shouldn't hurt THAT bad. Just sedate those with female organs I always say!

Two words: ethics committee.

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

Back in a day when mastectomies were kept overnight or for a day or two on our unit, I remember sometimes those women were in enough pain to recieve narcotics. (Our breast man started doing his surgeries as a day surgery, then retired, and the other breast man in the area uses another hospital for his inpatient surgeries, and I haven't seen any in a long time.)

I hope you guys call him at all hours of the night asking for more pain medicine.

But a lot of pain can be controlled with the power of the mind. When the patient asks for pain medicine and you approach the patient "here's your pain medicine", it might work.

But I agree with the others, it's not the best first-line pain medicine.

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

Back in a day when mastectomies were kept overnight or for a day or two on our unit, I remember sometimes those women were in enough pain to recieve narcotics. (Our breast man started doing his surgeries as a day surgery, then retired, and the other breast man in the area uses another hospital for his inpatient surgeries, and I haven't seen any in a long time.)

I hope you guys call him at all hours of the night asking for more pain medicine.

But a lot of pain can be controlled with the power of the mind. When the patient asks for pain medicine and you approach the patient "here's your pain medicine", it might work.

But I agree with the others, it's not the best first-line pain medicine.

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
MD's aren't allowed to write "q4-6 hrs" they had to SPECIFY like "q4 hrs" or "q6 hrs"......at least thats the new policy @ my hospital

We're just now beginning to address that issue. I think how we're going to handle it is the pharmacy automatically enters the order as "q4h" if the order says q4-6.

I called a doc for the first time the other day to clarify "what does qd mean?". :rotfl:

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
MD's aren't allowed to write "q4-6 hrs" they had to SPECIFY like "q4 hrs" or "q6 hrs"......at least thats the new policy @ my hospital

We're just now beginning to address that issue. I think how we're going to handle it is the pharmacy automatically enters the order as "q4h" if the order says q4-6.

I called a doc for the first time the other day to clarify "what does qd mean?". :rotfl:

Specializes in tele, stepdown/PCU, med/surg.

I personally don't mind 1-2mg q4-6 hrs type orders. I think it allows us to use our nursing judgement and gives us some leeway. Also, Do we really need a doctor to give us a rate for TKO? As a nurse, when I see a TKO order, I put it at 20cc/hr generally or even a little lower if there is something else flowing through same vein. While I do like docs to write clear orders...what's wrong with TKO or q4-6?

Specializes in tele, stepdown/PCU, med/surg.

I personally don't mind 1-2mg q4-6 hrs type orders. I think it allows us to use our nursing judgement and gives us some leeway. Also, Do we really need a doctor to give us a rate for TKO? As a nurse, when I see a TKO order, I put it at 20cc/hr generally or even a little lower if there is something else flowing through same vein. While I do like docs to write clear orders...what's wrong with TKO or q4-6?

Just my 2cents worth. At my hospital we get q4-6 hours and 1-2 tabs (both prn) all the time with out any problems. I agree it allows nursing judgement. Also Ativan is sometimes used for some types of pain, although I'm not sure how much good it would do for mastectomies, I was given Ativan 1mg q4-6hours prn for muscle spasms from a neurosurgeon and it did help with the pain. I do agree totally that post-op patients should have stronger pain meds available than just tylenol and ativan. If the patient does not need the stronger med fine but it should be available in case thay do. If one of our MD's don't order pain meds I just call them at 2am when the patient wakes up and get an order, usually at that hour they are cooperative. (HA HA)

Like I said just my 2 cents worth.

Just my 2cents worth. At my hospital we get q4-6 hours and 1-2 tabs (both prn) all the time with out any problems. I agree it allows nursing judgement. Also Ativan is sometimes used for some types of pain, although I'm not sure how much good it would do for mastectomies, I was given Ativan 1mg q4-6hours prn for muscle spasms from a neurosurgeon and it did help with the pain. I do agree totally that post-op patients should have stronger pain meds available than just tylenol and ativan. If the patient does not need the stronger med fine but it should be available in case thay do. If one of our MD's don't order pain meds I just call them at 2am when the patient wakes up and get an order, usually at that hour they are cooperative. (HA HA)

Like I said just my 2 cents worth.

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
I personally don't mind 1-2mg q4-6 hrs type orders. I think it allows us to use our nursing judgement and gives us some leeway. Also, Do we really need a doctor to give us a rate for TKO? As a nurse, when I see a TKO order, I put it at 20cc/hr generally or even a little lower if there is something else flowing through same vein. While I do like docs to write clear orders...what's wrong with TKO or q4-6?

Because you would put it at 20 cc/hr and I would put it at 50 cc/hr. The rate should be specified.

The q4-6 doesn't make sense to me if it's a prn med. Because anytime after four hours, be it 4.5 or 6 or 10 hours, the nurse can give it, using his/her own judgement. I definatley like dose ranges like 1-2 mg, but the frequency ranges don't matter to me, give the the lowest frequency and I'll take it from there.

If it's a scheduled med, our pharmacy has policies as to what time to give it.

What kinds of medications are you thinking the nurse can give q4-6h scheduled?

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
I personally don't mind 1-2mg q4-6 hrs type orders. I think it allows us to use our nursing judgement and gives us some leeway. Also, Do we really need a doctor to give us a rate for TKO? As a nurse, when I see a TKO order, I put it at 20cc/hr generally or even a little lower if there is something else flowing through same vein. While I do like docs to write clear orders...what's wrong with TKO or q4-6?

Because you would put it at 20 cc/hr and I would put it at 50 cc/hr. The rate should be specified.

The q4-6 doesn't make sense to me if it's a prn med. Because anytime after four hours, be it 4.5 or 6 or 10 hours, the nurse can give it, using his/her own judgement. I definatley like dose ranges like 1-2 mg, but the frequency ranges don't matter to me, give the the lowest frequency and I'll take it from there.

If it's a scheduled med, our pharmacy has policies as to what time to give it.

What kinds of medications are you thinking the nurse can give q4-6h scheduled?

I'm sorry, but I don't understand. The patient was a "breast man" who was lactating and the Dr. wrote a not very clear order for ativan

I'm with you, begalli, I'm DYING over here. :roll :rotfl:

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