I understand I'm supposed to pop out two tablets becasue the dosage is not sufficient to equip 10 mg with one tablet but shouldn't the MAR say the correct number of tabs and doesn't this promote med errors? Sometime the med orders do change and the old pharm card could be wrong as well. Looking for thoughts on this. I'm orienting at a new facility and made the mistake of popping only one tablet instead of two, yesterday I took the correct dosage of this medication but did the same thing on another order that was 600 mg and the tabs were only 200 each. How can I make sure I stop making this mistake? I'm sure once I know the residents and the meds I will not make it with them but I am afraid I will keep doing it. I know I'm supposed to check the dosage ect, but just hoping someone has any good advice. Perhaps I'm not cut out to be a nurse.
I just recently saw a similar order for insulin like that, come to find out, when I brought it to the attention of the NP, she rewrote the order to show only 1 and for a totally different amt of insulin. Your license is on the line so question things that don't make sense, even if you get heckled for it.
It would be two 50 mg tab. Ideally the order should be written ( metoprolol 50mg. Give two tabs po BID at 9am). An order should have medication name, dosage, quantity, route and time.
The doctors don't always know what dosages the med comes in. They should just be writing the dose.
In the LTC that I work at, the order will be written at the top (give 12.5mg of metoprolol) and then we have a spot that has additional info below that pharmacy will put in to say to give 1/4 of the pill. We use eMar.
When I work acute care, we would write to give 12.5mg of metoprolol in our paper MAR and then when we go pull it from our medication dispencing unit, we would the have to do the math and spilit the pill.
Specializes in Gerontology, Med surg, Home Health.
We write the dose and the # of tabs to be given. It's a regulation in Massachusetts in long term care. For example: Tylenol 325 mg tabs-give two tabs to = 650mg every 6 hours as needed for pain.
Some drugs don't come in the dose we need so we write (type since we use EMR) happy pill 10 mg tabs. Give two tabs to = 20mg.
If it's an odd dose, each med must be signed off in a different box. For example: loopy pill 5 mg tab daily (give with 15mg tab to =20mg)
The next says: loopy pill 15 mg (give with 5 mg tab to = 20mg)
I'm not understanding the confusion as to how to enter the order. If every nurse gets on the same page with entering the order, then confusion greatly decreases. I will quote myself again.
"The way we enter meds is like this:
Ok, so we have an order for hydralazine 25 mg.
When we enter it into the computer, we do NOT select "Hydralazine 25 mg," which IS an option, but that is telling pharmacy to specifically spend 25 mg pills.
We select Hydralazine tablet.
Then underneath, we enter dose: 25 unit: mg
This allows the pharmacy to fill the med how they see fit, really eliminating med errors.
Hydralazine wasn't a good example. Of course they will send 25 mg tablets.
But it helps tremendously with other medications."
Quoting yourself using the same poor example does not help. If there is only one form of the medication (i.e. 25mg tablets)
The Lasix example was better in that there are 10mg and 20mg tablets available. My question might have been better worded if I said, "Does Pharmacy change the order every time they send a different combination of tablets. Do they have one order for three 20mg tablets then change the order if they were to sent one 20mg tablet and one 40 mg tablet?"
This is the exact confusion I was referring to. Is the "Metprolol 50mg" the dose or the tablet strength?
I don't know, and that's why it's confusing. I really don't think # of tablets has a place in the order at all. If it's there then it needs to be more specific. Like metoprolol 50mg, 2 tablets to = total dose of 100mg. The total ordered dose needs to be included and specific without all the room for interpretation.
Since the actual # of tablets depends on the pharmacy supplying the medication, I really don't think it belongs in the medication order. That just increases the opportunity for misinterpretation and medication error. On this thread my example has already been interpreted different ways.
Unfortunately, the example is actually reflective of similar orders I see frequently when LTC patients are admitted to the hospital.
We write the dose and the # of tabs to be given. It's a regulation in Massachusetts in long term care. For example: Tylenol 325 mg tabs-give two tabs to = 650mg every 6 hours as needed for pain.
Some drugs don't come in the dose we need so we write (type since we use EMR) happy pill 10 mg tabs. Give two tabs to = 20mg.
If it's an odd dose, each med must be signed off in a different box. For example: loopy pill 5 mg tab daily (give with 15mg tab to =20mg)
The next says: loopy pill 15 mg (give with 5 mg tab to = 20mg)
What regulation are you referring to? Massachusetts, like most states, differentiates between how an order should read, and how a that label should be interpreted by a pharmacist when it is dispensed for self-administration, but I can't find anything that says nurses in long term care should be administering off of a label meant for self administration, and actually the regulations seem to contradict that.
Iknowwha2du
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I just recently saw a similar order for insulin like that, come to find out, when I brought it to the attention of the NP, she rewrote the order to show only 1 and for a totally different amt of insulin. Your license is on the line so question things that don't make sense, even if you get heckled for it.