Is Ativan 10 mg po per dose too much?

[lorster]

Last night a 49 year old male patient was admitted to our med surg unit with R/O PE which was later ruled out. He also had a history of anxiety. Admitting doctor ordered 5 to 10 mg Ativan po Q 4hrs prn. Evening shift nurses questioned it and called the doc on call who quickly changed it to 1 mg Q 4 hrs prn. This morning, the primary doctor comes in and throws a huge fit on the floor. Why didn't my patient get 10 mg Ativan last night???. I explained to her that we have a right to question orders like that and her partner on call changed it. Our pharmacy states max daily dosage should be 10 mg divided over 2 to 3 doses. Also, this patient had taken Ativan only one other time in his life. So...could I get some feedback? I had to write an incedent at the doctors request. Thanks fellow nurses :)

[shortd]

Holy jeez! How about just writing an order to take a 2x4 to pt's head? Call the doc, question to see if was a typo, then make an SBAR note of the exact conversation and make a copy of the order. I'd be more party to it if he was intubated and on HR, RR, o2 sat, and bp monitoring. Have flumazenil at bedside.

Week ago I had an etoh DT pt with an order to start an ativan gtt at 4mg/hr. I liked that order because of past experiences with DT pts but I titrated starting with 2mg/hr because he settled down when I decreased some of the restraints, turned off the lights, and began talking to him about his work, family, etc. During report night shift and I decided to go to 4mg/hr just so we wouldn't have any more outbursts and it was a specific order. Literature is saying now to try other meds since benzos can give frightening hallucinations, cause hypoactive delirium or paradoxical effect.

Other side, we transferred a pt to med/surg only to be returned the next day because the nurse did not give his scheduled ativan, a pt addicted to benzos and a history of d/c'ing 7 piccs, his wound vac over an appox 6x10 abdominal incision, and a t-tube drain during anxiety episodes. She charted she gave it but told the doc she didn't give it. Whoa, go back and re-chart before you admit you falsified a pt's medical record.

Sad story, he went back to the floor without a med/tele box even with a HX of recent cardiac events and coded, has an anoxic injury, GCS of 8 now.