Med error?

Specialties Pain

Published

I have a question regarding pain meds. Let's say you have a patient with kidney stones that it awaiting surgery, until then you are keeping them comfortable with pain meds. Ordered meds are norco 10mg q4 prn for moderate pain and dilaudid 0.5mg q2 prn for severe pain. Pt is a large built male, tolerating meds without issue except always has a pain level of 8. Has been in hospital for a day, dilaudid is given for initial pain of 8 and norco is given at the same time for when the dilaudid wears off. Nurse A says this administration method is ok bc the dilaudid acts in about 15 minutes and wears off in about 45 minutes to an hour, and the norco doesnt start to work for about 45 minutes to an hour. Nurse B says this is incorrect and the norco must be given first and dilaudid given 45 minutes to 1 hr after. Nurse A believes Nurse B is incorrect because both meds would be kicking in at the same time with Bs administration method. What do you all think? Note: patients pain is more controlled with As admin schedule vs Bs.

Are all the details correct? for example, "dilaudid 0.5mg q2 prn for severe pain", "dilaudid acts in about 15 minutes".

According to the Dilaudid dose 0.5 mg and other details you provided, it seems that Dilaudid was given as S/C or IM injection, as oral Dilaudid tablet would take up to 30 minutes to begin to work. However, it only takes about 15 minutes for Dilaudid injection to begin to work.

Obviously injection can potentially cause discomfort to the patient.

As Norco 10 mg is tablet, why don't the doctor give Dilaudid tablet? If Dilaudid is given as tablet, the dose 0.5 mg would be quite lower. The lower Dilaudid dose could be due to kidney disease.

If Dilaudid 0.5 mg is tablet, how to split Dilaudid 2 mg tablet in order to get 0.5 mg?

In Australia, Dilaudid tablet only has three strengths: 2 mg, 4 mg, 8 mg.

Is Dilaudid 0.5 mg oral liquid? As Norco 10 mg is tablet, in other words, the patient can tolerate tablets. Why don't the doctor give Dilaudid tablet?

Norco can be used to treat moderate and slightly severe pain, and Dilaudid can be used to treat severe pain. Meanwhile, Dilaudid with a lower dose can be used to treat moderate pain.

It is not a routine for doctors to write "Moderate pain" or "Severe pain" on medication chart. What I commonly observed is "Indication: pain".

Are all the details you provided correct? If so, is this doctor an experienced practitioner or internship?

Moreover, you didn't provide regular pain medications. You only provided prn pain medications. It is not convenient for others to discuss more in depth.

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Perhaps Dilaudid 0.5 mg is oral liquid.

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Specializes in Transitional Nursing.

If the order is worded "pain greater than 5" etc. I'd say its not an error. If the order is written for moderate pain give x and for severe pain give z, id say its an error.

If it were me I'd give the dilaudid for severe pain and 30 minutes later the norco for moderate pain.

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Specializes in orthopedic/trauma, Informatics, diabetes.

We have to give PO first and then the IV. Min of an hour apart. Not sure why they would use Norco. We use oxy/PO dilaudid and tylenol separate

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