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

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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Two words: ethics committee.

You think I should? Will I get fired? Our manager is pro-nurse but he is also an MBA and pro making happy docs.

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Two words: ethics committee.

You think I should? Will I get fired? Our manager is pro-nurse but he is also an MBA and pro making happy docs.

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I don't mind the 4-6 hour part, its the overall ignorance of the way he obviously thinks that bugs me. Ativan is a fabulous adjuvant med (to narcotics and NSAID's), and I insist on an Ativan order with my suspected DT's! I don't like the fact that he writes (pre-printed) for Ativan specifically for pain, and when I asked for alternate pain meds he said "give the 2 tylenol). This is 30 minutes post op. Thanks for the responses.I have to think on this one. May be one for Ethics(if we have one)

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I don't mind the 4-6 hour part, its the overall ignorance of the way he obviously thinks that bugs me. Ativan is a fabulous adjuvant med (to narcotics and NSAID's), and I insist on an Ativan order with my suspected DT's! I don't like the fact that he writes (pre-printed) for Ativan specifically for pain, and when I asked for alternate pain meds he said "give the 2 tylenol). This is 30 minutes post op. Thanks for the responses.I have to think on this one. May be one for Ethics(if we have one)

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

Really, 3rd shift guy? :icon_roll

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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.

Do you mean say "Here's your pain meds" and not give it to them?

Or you do notice as soon as you approach a pt and say "Here's your pain meds" they quiet down because they know relief is in sight.

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Specializes in Critical Care/ICU.
I called a doc for the first time the other day to clarify "what does qd mean?". :rotfl:

We do this all the time because as we all know, JCAHO has us eliminating "dangerous" abbreviations. :stone

If I don't bug the docs and take a verbal spelling out daily (instead of qd), or look over the docs shoulder as they write the order to make sure it's right, the pharmacy will send it back to get me to call the doc and get it "clarified" anyway. It slows the pharmacy and patient care down cause pharmacy won't make a drug available in the pixis until the order is written "properly" (emergencies excepted of course).

We can no longer use:

U

IU

QD

QOD

Trailing zeros (eg: 1.0 mg)

MS

MSO4

MgSO4

ug

hs

SC

SQ

d/c

cc

au, ad, as

For the most part everything needs to be spelled out. :yawn:

Is that what you meant ThirdShiftGuy?

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Specializes in Family.

I always set my rate so that a bag was used in a little less than 24 hours. I don't know if bag changes q 24 was policy, but I felt more comfortable doing it that way.

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Specializes in NICU.

If a doctor ever orders something in cc's, we are to clarify with them that they really meant mL. It's basically like that for most, if not all, of the abbreviations begalli listed. (I'm not saying we religiously do this, but we're supposed to)

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We do this all the time because as we all know, JCAHO has us eliminating "dangerous" abbreviations. :stone

If I don't bug the docs and take a verbal spelling out daily (instead of qd), or look over the docs shoulder as they write the order to make sure it's right, the pharmacy will send it back to get me to call the doc and get it "clarified" anyway. It slows the pharmacy and patient care down cause pharmacy won't make a drug available in the pixis until the order is written "properly" (emergencies excepted of course).

We can no longer use:

U

IU

QD

QOD

Trailing zeros (eg: 1.0 mg)

MS

MSO4

MgSO4

ug

hs

SC

SQ

d/c

cc

au, ad, as

For the most part everything needs to be spelled out. :yawn:

It's things like this that drove me out of the hospitals. JCAHO is making hospitals unworkable places. I see their policies as more of a hindrance than a help to patients. How can you be there for your patients if you're on the phone with a doctor everytime he/she writes down an abbreviation?

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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

Actually, any Hospice nurse will tell you Ativan can augment the pain med, because it does help reduce the anxiety associated with cancer pain, i.e. fear of severe pain & suffereing. We use it in the nursing home when res. are experiencing pain & cannot have another analgesic 'yet' due to rigid physician's orders. Not all physicians truly understand pain or narcotics, so Hospice nurses are great to have on your side.

When used for this reason, the Ativan is usually a low dose, not something to snow them & mask symptoms. But then again, being snowed might be what someone needs in order to give the pain med time to get ahead of the pain. When dealing with severe cancer pain, it is important to stay ahead of the pain, thus the need for breakthrough pain meds. Ativan can help with this.

If it was me, I'd rather be snowed for 3-4 hrs. allowing the analgesia time to work, than deal with such severe pain that I cannot relax or sleep at all. Hope this helps. DNS

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