I am missing something obvious?

[missmollie, ADN, BSN, RN]

Is there a reason why we would give a PO medication to a patient who is vomiting? I can understand giving that prescription to someone at home with no option but PO, but in the hospital when the patient has IV access...what am I missing?

[Boomer MS, RN]

Is there a reason why we would give a PO medication to a patient who is vomiting? I can understand giving that prescription to someone at home with no option but PO, but in the hospital when the patient has IV access...what am I missing?

I don't think you're missing anything, but you did not specify what the medicine is. I would call the MD or the NP, whatever the case may be.

[roser13, ASN, RN]

Before you call, make sure the order was transcribed correctly (unless you transcribed it yourself).

[AJJKRN]

If the med was phenergan, we're under a national shortage of IV. So says my workplace.

[smf0903]

If the med was phenergan, we're under a national shortage of IV. So says my workplace.

Yeah we haven't had IV phenergan for about a month now.

[smf0903]

Curious, too, about the med. Some meds can't be given IV in order for them to work. PO vanco for c-diff comes to mind just as an example.

[Boomer MS, RN]

Yeah we haven't had IV phenergan for about a month now.

Many places do not give IV Phenergan anymore, even in a 50 ml bag. It's off the formulary. I'm surprised to hear that is still being used, as some of you have indicated here. I didn't know there was a shortage of IV though. What about Zofran or Reglan?

[Been there,done that, ASN, RN]

Any one who is vomiting.. must be NPO. They can't keep anything down and stimulating the GI tract will exacerbate their GI issue.

You would not administer po anti-emetics, for active vomiting in the home or the hospital. You need to obtain an order for a different route of administration.

The sub-lingual, IM, IV, or rectal route of administration is now required.

[missmollie, ADN, BSN, RN]

I had an order for IV zofran, which I gave. 30 minutes later the poor patient is still getting sick, and the doctor put in an order for PO Phenergan. I didn't realize there was a national shortage. We still have IV phenergan in our pyxis, I checked. I work at a university hospital, so I didn't know if the first year just didn't understand or if I should have made it more clear. I was perplexed because I asked specifically for zofran IV with no issue, I didn't think I would need to ask for IV, as it was obvious IV was needed. Or maybe rectally, sublingual...anything but a pill.

Thanks all.

[smf0903]

Many places do not give IV Phenergan anymore, even in a 50 ml bag. It's off the formulary. I'm surprised to hear that is still being used, as some of you have indicated here. I didn't know there was a shortage of IV though. What about Zofran or Reglan?

We never get Reglan orders. Our docs are quite partial to zofran and phenergan. I was told we wouldn't have IV phenergan until May/June.

[Boomer MS, RN]

I had an order for IV zofran, which I gave. 30 minutes later the poor patient is still getting sick, and the doctor put in an order for PO Phenergan. I didn't realize there was a national shortage. We still have IV phenergan in our pyxis, I checked. I work at a university hospital, so I didn't know if the first year just didn't understand or if I should have made it more clear. I was perplexed because I asked specifically for zofran IV with no issue, I didn't think I would need to ask for IV, as it was obvious IV was needed. Or maybe rectally, sublingual...anything but a pill.

Thanks all.

The first year resident may have ordered Phenergan PO because it is not given IV in may places anymore because its pH is so low (4, I think), and it can be a vesicant with devastating results. He may have thought PO is better than nothing! I love Phenergan but understand the concerns. Compazine is given PR too. When I would get stumped trying to help the patient and the resident, I often called a pharmacist, who was my savior more than once. That is terrific that you are in a University Hospital, where you have many resources.

As I said before, I'm stunned that Phenergan is still being used. But maybe if it's in a 50 ml bag of NS and given over 15 minutes, that is acceptable at some places. I few years I was very nauseated post-op and tried everything with no relief. I begged the Fellow for Phenergan, and he ordered a tiny dose IM, which gave me relief.

[BSN16]

to be honest i have never actually seen any oral antimetic medications. almost every pt has IV zofran or compazine