Inconsistencies when checking safe doses/different sources

[anon456, BSN, RN]

Yesterday I had a pediatric patient who was prescribed their first dose of vancomycin. I checked two sources provided by my workplace for nurses: one on the computer and one in book in the med room. I checked both sources because there was a difference in what the sources said were safe doses and what the ordered dose was. It was a significant difference. Both of my sources said the max dose for a patient of this age (for any kind of infection/condition) was 40mg/kg/day divided in 4 doses per day. I checked both sources, and even asked a co-worker to check for me thinking I was missing something, before going to the doctor about my concerns.

The doctor then pulled up his own guideline on his computer, a different reference than what the nurses are able to use. His reference said 14mg/kg/dose given every 6-8 hours. My patient's order was for every 6 hours, which would make their dose 56mg/kg/day. I called the pharmacy to confirm this and they agreed with the doctor.

The doctor was very nice about the whole thing, but it annoyed me that I was trying to be safe for this patient, but we were using different sources of reference. The only good thing about this is that patient will get vanco troughs here and there to make sure their levels are safe. It may not be so for other meds.

Has anyone else experienced this before?