Is this a Med Error?

This thread is getting confusing because the original post said that the order was TID and later on the OP mentioned TID PRN. Please make sure you know the difference between scheduled & PRN meds.

If it was indeed PRN, was the pt asking for it or exhibiting signs that the med was needed, or did you administer it because you thought it was scheduled?

I would say this starts as a transcription error, as no time was written into the MAR...and then follows into an adminstration error. If you did not follow the gazillion rights, which includes knowing the medication (had you looked it up you probably would have seen that it has a peak of ~3 hours so two doses close together might be unsafe for the patient) and then called for clarification and a new order for the appropriate times to be administered. That said, you could easily have walked away and not said anything. You reported and advised the MD. This is a learning experience, of which there will be many! Feel better

I could see giving a muscle relaxant med ordered for TID PRN, closer together than 8 hours. Say, the patient takes one when he wakes up, but then likes an additional dose prior to physical therapy. But if a patient asked for a second dose less than 8 hours from the first, I would page the provider to verify it's ok to give that close together. If the patient will be in the hospital for a while, and this is his habit, then I would suggest to the provider to add or amend the med orders to say it's ok to give close together for PT. Otherwise, I would page every day to confirm it's ok, just to cover my butt.

If you had other patients assigned to you, you shouldn't have left the floor to follow the escaping patient. You should just notify the charge nurse, call security. I'm not sure it's ok even for the CNA to follow alone. Your hospital should have policies and training on that. Safety first.

I hate those kind of orders!!!! I don't believe that it was a med error. TID can mean anything. To me, that Q8H. Some are TID w/meals. Some are 8 12 2100. They need to be more specific and I will ask that orders be clarified and/or timed to avoid such a situation.

TID is not the same as q 8hrs. For scheduled medications, TID means the medication is scheduled for the defined times for that medication, which might be 0900, 1300, and 2100, as an example.

TID prn means it can be given 3 times in a day.

Technically It is not but, think about it this way, if you get an order for Oxy 10 TID PRN, are you going to give every hour x 3 just because the order says TID PRN? I guess you won't. Orders like this needs to be clarified unless you have a hospital policy or unit policy about it. Also please make sure you clarify with appropriate people. If it's an MD get their name and put it as comment in MAR or write a nursing communication order.

I was in a facility as a patient where I had Xanax prescribed to me 4 times a day. I was confused when they tried to give me my 2nd dose of the day just 4 hours after receiving my first one. I told them I just got my Xanax a few hours ago, that I didn't need it. They said their policy was different in that facility. They divided the doses up over a 12 hour period during the day. So I don't think this is a cut and dry case. It is definitely confusing as to if it is a med error.

I have had prescribers give instructions for cases just like this. Ex. Order may be TID with a note stating med should be given no less than 4 hours apart. That gives nurses the legal leeway to use nursing judgement.

As a new grad myself i would certainly question the medication order. I work for a rehab hospital all of our PRN medications usually have a frequency written behind it. Given the fact that this medication is a muscle relaxant i certainly would not give this medication at 9 10 13 like you said the supervisor mentioned.

Keep in mind you always have to CYA.

My question to the senior nurses if this patient would have gone into respiratory distress or coded how do you think this situation would be in a court of law? Im sure you cant say the medication order was written TID PRN so i could give it whenever.

It sounds like a recipe for disaster.

On 9/25/2019 at 2:04 AM, AllyRN said:

So I asked someone who I thought was a nurse because she had a stethoscope on, a WOW, and she had been on the unit since change of shift. She said it was fine. BUT BIG SURPRISE, she’s a respiratory therapist and I didn’t discover that until after giving it(not saying that there’s anything wrong with RT’s, but I was looking for a RN).

At first I thought you were joking. I don't care who it is (but really???? just approaching a random person for info-and taking their word as Gospel- just because they are wearing scrubs and a stethoscope???). YOU are responsible for every medication you give. If you don't know enough about the medication, you LOOK IT UP, you clarify with the doctor. If something seems fishy, you go to sources YOU KNOW to have the proper credentials. And in the end, you use your own nursing judgment to make the appropriate decision, and once you've done so, you own that decision and the consequences of it. "Well, so and so told me it was okay" will never cut it if something bad happens. It won't cut it even if it's a doctor, because it is your responsibility to investigate and refuse to give a medication, even in the presence of a written order, if it is inappropriate. Most of us have had to tell a doctor that we are not going to give a medication for such and such reason. In the case of outright physician mistakes, many have thanked the nurses profusely for not giving the med as ordered and bringing it to their attention.