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Innumeracy

Nurses   (1,302 Views 23 Comments)
by Oldmahubbard Oldmahubbard (Member)

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An NP I work with couldn't figure out that 150 pills dispensed in the community since February this year did not equal tid dosing.

A BSN I work with could not figure out how to order 125 mg of a drug that only comes in 25 mg, 50mg, and 100 mg.

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VivaLasViejas has 20 years experience as a ASN, RN and specializes in LTC, assisted living, med-surg, psych.

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That is just plain scary.¬†ūüėģ

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Davey Do has 35 years experience and specializes in Psych, CD, HH, Admin, LTC, OR, ER, Med Surge.

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3 hours ago, Oldmahubbard said:

A BSN I work with could not figure out how to order 125 mg of a drug that only comes in 25 mg, 50mg, and 100 mg.

Wrongway pharmacy would dispense two 100mg tabs and have the nurse cut one of them in quarter pieces.

Really.

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AnnieNP has 20 years experience as a MSN, NP and specializes in Adult Primary Care.

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42 minutes ago, Davey Do said:

Wrongway pharmacy would dispense two 100mg tabs and have the nurse cut one of them in quarter pieces.

Really.

Davey Do,

Again, you make me laugh out loud!!!!!

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TriciaJ has 37 years experience as a RN and specializes in Psych, Corrections, Med-Surg, Ambulatory.

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4 hours ago, Davey Do said:

Wrongway pharmacy would dispense two 100mg tabs and have the nurse cut one of them in quarter pieces.

Really.

You could also smash them up and carefully weigh out the milligrams.

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not.done.yet has 8 years experience as a MSN, RN and specializes in Critical Care; Cardiac; Professional Development.

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I believe it. If you ever want to really have fun, watch someone at a cash register try to make change after the drawer is already open and the machine can't tell them what to give.

In fairness, I do not do math in my head well either. I would be the deer in headlights in that situation.

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GrumpyRN has 35 years experience and specializes in Emergency Department.

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9 hours ago, Davey Do said:

Wrongway pharmacy would dispense two 100mg tabs and have the nurse cut one of them in quarter pieces.

Really.

Used to do that with Captopril, it came in 50mg tablets, dose was 12.5mgs and the tablets had a very nice crossline on them to break them into 4 bits. 

 

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myoglobin has 11 years experience as a ASN, BSN, MSN and specializes in ICU, trauma, neuro.

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In defense of the nurse in question they may have been trying to keep it in "equal doses" without cutting pills (one of the things beat into our heads in NP school was that if you have patients cut pills or take multiple doses they are unlikely to be compliant and we were marked down on care plans that featured such mechanics when it could be simplified with a different equally effective medicine or dosage form) in which case it could be rather challenging.  Also, I was exponentially more adept in calculating in my head during my "early college years" when I was constantly doing this for the algebra, calculus, and nursing med/calc classes that I was taking. At one point in college I could breeze through differential equations and complete 10 step dosage calculation problems in Chemistry with no problems. However, now I would struggle with many of the questions on my BSN dosage calc. quizzes.  It's  like anything else "use it or lose it" in the same way that it has taken me months of 90 minute workouts to get back to 50 push ups (when I used to be able to do 75), it would take me awhile (if ever) to get the "mental fitness" to do very much dosage calc. by hand.  These baseline skills (for a new NP) take up a greater percent of their "cognitive processing power" when they start and as they gain proficiency it tends to be less cognitively taxing. 

Edited by myoglobin

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All you have to do, if you don't know off the top of your head is set up a math problem. 

125 mg/x  100 mg/1 tablet =1.25

 

I am used to taking test to get jobs. Things are different now, if you do take a test you are given the answers or very few math calculation problems. The people that last in the job aren't the math skilled types but rather the, I am willing to take the most bullshaz. When you look at the mar, it tells you how many pills the patient needs to get, all you have to do is cut them. The question is how do you check that what your doing is correct if your math skills suck.

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adventure_rn is a BSN and specializes in NICU, PICU.

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Tangentially related, but I once had a teenage patient who was very particular (on the spectrum) and insisted that each of his 15+ meds be cut up into 1/4s or 1/8s (if we could physically make them that small) before taking the pill fractions one at at time, each with 3-5 minute breaks in between. His morning med pass took nearly 2 hours.

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