Med administration

[Succubus]

Hello. I am looking for support or guidance on some issues I’ve run across lately in LTC and in other specialties. I have been an lpn since 2011 and just recently acquired my RN. I  was offered and accepted a position as a night shift supervisor at a detox unit. Recently I’ve noticed nurses “interpreting” drs orders when the order is unclear. Ex: 100 mgs of doxy given twice a day but order written as give 40mg x 2.5 tablets by mouth twice a day. I was always taught that the medication label must ALWAYS match the MAR. In this instance the math is still accurate but it doesn’t match the order. 
Did I imagine this in nursing school? Every nurse that I’ve talked with reiterated that the order was correct. Now I’m feeling a bit unsure. I’ve scoured the internet looking for information on the matching the order with the mar. Am I overthinking this? 

[Miriam_the_nurse, BSN, MSN, RN]

In the example that you give, the staff does not interpret the orders but carries them out. It is very common to write orders the way you stated. There is no interpretation - it is math and figuring out what kind of pills are being dispensed to ensure that staff knows how to administer the total dose.  Also, the order is not unclear - it clearly states how many mg to administer. I guess you are still in the transition from LPN to RN. ?

[JKL33]

On 11/30/2022 at 2:50 PM, Succubus said:

I was always taught that the medication label must ALWAYS match the MAR.

You were taught that in a very specific context. That being: The 5 Rights must match.

The idea that there is only one right way to achieve the ordered number of mgs is a newer matter that came about (as far as I can tell) with electronic MARs and with the idea that the order and MAR needed to match exactly, even though MARs themselves introduced some new problems (like what if it isn't possible to enter an order in the electronic system exactly the way it was written by the prescriber).

Prior to that the order would just state "Lasix 20 mg po QD" and the nurse would hand-transcribe that to a paper medication administration record and then it was up to the nurse to decide how to deliver the 20 mg based on what pills were on hand, such that if s/he only had 10 mg tabs available two would be given, if 20mg tabs were available one would be given, and if only 40s were available it would need to be cut in half.

It is both correct and incorrect to state that the MAR **must** match the order. Correct in that it can't be the wrong med, the wrong dose, the wrong route, for the wrong patient, etc, etc., In other words the 5 Rights have to match.

Incorrect (from a common sense standpoint) to have the idea that it's a universally understood ERROR/mistake if the nurse gives (1) 100 mg tab instead of (2.5) 40 mg tabs. They are both 100 mg of the correct medication.

Do all the 5 rights match (patient, med, dose, route, time)? Yes.

 

I also agree with the post above me, there is no interpreting going on in your example and the order is not unclear.

[kbrn2002, ADN, RN]

As long as the dose given matches the dose ordered it's not an error.  What's  likely happening in this situation is simply a limitation of the software used by the provider or the nurse entering the provider's orders. 

I run into this all the time when entering orders. The software we use requires inputting a dose from a drop down menu that may or may not match the total dose ordered so then the order reads something like that "give  40 mg x 2.5 tablets" simply because the order can't be entered by putting in the actual ordered amount of 100 mg if there is no 100 mg choice in the drop down menu.

It's not ideal, but the order has to be entered somehow so whoever inputs the order just has to work with what the available dosage is and trust that the person administering the med focuses on the actual ordered dose and not the tablet dose used to get to that dose that was entered.