Lovenox question.

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To go with my other post "feeling bad because i didnt go with my gut"...just a question-MD gave order for lovenox 80mg subq STAT...what we had in the facililty was lovenox 40mg....when I went to get it from the nurse who had it she said "NO, you cant give two lovenox injections at the same time!!" and another nurse agreed with her, she said "No, you NEVER do that". I said ok well i will have pharm stat it out then...later on when things calmed down i inquired about why you cant give two injections. i checked drug book and didnt see any indication that you shouldnt. my DON/ADON said they didnt see any reason why you shouldnt. I asked the nurse who said it, and she said "well its a personal thing, i just wouldnt-its my license on the line" and i said why do u say that? and she says i just wouldnt because of the drug itself and what its for... i said i dont see why you can't give 2 40mg injections one in each side of abdomen...she kept saying "as a nurse, i just wouldnt". So my question to the experienced nurses (unlike myself!) is....would you give 2 injections, and why or why not??

PS-pt ended up going to ER before the lovenox arrived, and MD was paged so I could claify to give 2 doeses or not, and page had no been returned by the time pt went to ER so it ended up not mattering in this situation by my mind is still inquiring....:confused:

Specializes in Rehab, Infection, LTC.

we had a pt with 150mg lovenox daily ordered. the nurse that was the regular nurse on that hall has only been a nurse for about a year. one night she decided that the dose was too much for the pt and she started giving him 40mg because "that was a better dosage".

needless to say...the pt is in the hospital right now with a DVT.

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Specializes in mental health + aged care.

While not an experienced nurse myself (still one semester shy of registration), I have worked with experienced nurses who are willing to give lovenox (well, actually it's Clexane in New Zealand, generic name enoxaparin - but same drug) with two injections, including once when the prescribing GP was right there in the house

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we had a pt with 150mg lovenox daily ordered. the nurse that was the regular nurse on that hall has only been a nurse for about a year. one night she decided that the dose was too much for the pt and she started giving him 40mg because "that was a better dosage".

needless to say...the pt is in the hospital right now with a DVT.

Ahhhhh, so I see my facility is not the only one where nurses think they can just change medications and medication doeses "because i know what im doing"......*shaking my head*

and to MassED- i do have a drug book that i frequently reference, its my best friend :D Sometimes I think some nurses put on a front to make it seem like they know more than they actually do...and then when someone like myself questions them for a rationale, they don't know what to say....:jester:

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Specializes in mental health + aged care.

I was also thinking about the cost of the drug and looked it up. 40mg enoxaparin sodium injection costs $52.30 New Zealand dollars for 10. That's $10.46 NZ for that 80mg dose, probably $7 or $8 US. Compared to the cost of having to assess and treat the patient for DVT/PE...

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Whenver you're giving "2 doses" of anything, it is a good idea to think about it for a moment. As it often can be a sign that you're about to make a mistake. But sometimes you think about it, and yep, it's what you're supposed to do.

If I had easy access to subQ needles though, I'd have combined them into one syringe so the patient wouldn't have to get 2 shots. (As for the "prefilled with air" thing, you can put your own air bubble in the syringe you combined them into.) But an extra needlestick in a case like this isn't too big of a deal.

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Specializes in Cardiac Care.

I agree with the previous posters...

For a STAT order of 80 mg, and if all I had were 40's, I wouldn't have hesitated to give the two injections. I'd explain it to the patient and give it bilaterally, but I'd have no problem with this. I wonder why the pharmacy couldn't just send an 80 mg dose syringe.

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Specializes in Rehab, Infection, LTC.
Ahhhhh, so I see my facility is not the only one where nurses think they can just change medications and medication doeses "because i know what im doing"......*shaking my head*

and to MassED- i do have a drug book that i frequently reference, its my best friend :D Sometimes I think some nurses put on a front to make it seem like they know more than they actually do...and then when someone like myself questions them for a rationale, they don't know what to say....:jester:

maybe we work in the same facility, lol

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Specializes in Nurse Scientist-Research.
I was also thinking about the cost of the drug and looked it up. 40mg enoxaparin sodium injection costs $52.30 New Zealand dollars for 10. That's $10.46 NZ for that 80mg dose, probably $7 or $8 US. Compared to the cost of having to assess and treat the patient for DVT/PE...

You may have heard of many Americans that order their meds from Canada? I investigated this for my MIL once and I believe for a while she was getting her meds from New Zealand!

In fact, I just checked my healthplan's pharmacy and if I bought a 31 day's supply, each dose would cost $29. My co-pay wouldn't be near that much. They have a chart where they show how much one's co-pay would be & how much your employer pays and the total for a 31 day supply was $100 co-pay + $811.54 from the employer.

Will a healthcare facility do what was described above to save $900/month?

You betcha.

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Specializes in ER.
Ahhhhh, so I see my facility is not the only one where nurses think they can just change medications and medication doeses "because i know what im doing"......*shaking my head*

and to MassED- i do have a drug book that i frequently reference, its my best friend :D Sometimes I think some nurses put on a front to make it seem like they know more than they actually do...and then when someone like myself questions them for a rationale, they don't know what to say....:jester:

I agree. Those EGO's! If someone asks me a question and I don't know, nursing has taught me to say "I don't know the answer to that, but I'd love to know - I'll help you find the answer!" I hate eating crow, but I've learned to do it gracefully - I like it when someone owns up to a mistake or simply doesn't know everything. I liken it to the GP who refers out to a Podiatrist for a weird foot problem. Nice when people know their limitations.

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Specializes in ER.
I agree with the previous posters...

For a STAT order of 80 mg, and if all I had were 40's, I wouldn't have hesitated to give the two injections. I'd explain it to the patient and give it bilaterally, but I'd have no problem with this. I wonder why the pharmacy couldn't just send an 80 mg dose syringe.

I wonder if it's a nursing home where this occurred and no pharmacy on site?

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If you don't have an in-house pharmacy you will have to wait a day at least to get the dose you need. Md who ordered dose should be able to answer question about 2 40mg doses to make an 80mg dose. And I have spoken to many patients who have found out that Lovenox is quite expensive if their insurance does not cover it.

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I used to be a pharmacy tech...we sent up 2 syringes for doses in carts all the time (syringes only go up to 100 and we'd have pts on doses above that). It was apparently just fine as it was the hospital's practice. But, as with all prefilled syringes...make sure you note they usually come with a little overfill :) All you'd be doing by putting them into one new syringe in increasing the risk of giving your pt a lovely little HAI.

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