Medication order correct or no

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So I just started working at a facility but the medications are written differently than I’m used to.
500mg, 2tabs, twice a day.

whats correct 2 250mg tabs or 2 500mg tabs?
in hospital setting it always says total mg to be given not total tablets.
the reason I’m asking is because the nurse training me says it’s 2 500mg tabs equalling 1000mg. The doctor also verified and said yes 1000mg however all his orders are written like this and I’m uncomfortable with it, it’s confusing and I’m not sure it’s written according to standards? Can I get in trouble for giving 1000mg in this case sense it states 500 mg. I’m not able to clarify every order he’s writing this way, there are way too many.
Thanks!

10 hours ago, Nursee1234 said:

I would totally consider that order to be for 500 mg. Period.

I would not.

But I agree it is written poorly, guaranteeing that it will be read two different ways.

11 hours ago, Mqnurse13 said:

The doctor also verified and said yes 1000mg however all his orders are written like this and I’m uncomfortable with it, it’s confusing and I’m not sure it’s written according to standards? Can I get in trouble for giving 1000mg in this case sense it states 500 mg.

If you are concerned about it, just document having clarified it with the physician. You could even re-write the order based upon your clarification using the following format:

"Clarification of [medication name] order: [Medication name] 1000 mg by mouth two times daily. VORB Dr. X/[Your signature]."

You will have to clarify with the provider any time you have a question about an ambiguously-written order.

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This thread alone shows that it's risky to administer this kind of order without clarification. On the med you called about, I would write a note with what you clarified. Then I would call the provider to clarify all orders written the same way. He can't make one blanket "This is what I always mean when I write orders incorrectly" statement. Where are you to document such a clarification? He will not like you. Your manager might not like you. Your job isn't to be liked though; it's to protect patients. I HIGHLY doubt the provider is ordering all medications for your facility ensuring that the available concentrations never change, so there's no way he can accurately prescribe a "tab-based" dose. (Other than something dumb like 1 tab multivitamin with iron, maybe)

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

That medication may not be available as either a 500 mg or 1000 mg tablet. There are missing elements in that prescription though. The rule for prescription writing (which still applies with current EMR systems) should read:

Drug Name 500 mg tablet, take 2 tablets by mouth twice a day.

or

Drug Name 250 mg tablet, take 2 tablets by mouth twice a day.

Those specifics should appear in medication bottles the Pharmacy prints out.

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i am amazed that you need clarification for this order. the medication may not be available in 1000 mg tablets, that is why it is written 500 mg, 2 tabs. if you give 2 250 mg tabs that would be a medication error because that is equal to 500 mg one tab. when i was in long term care the orders had to be written to match what mg tab we had in stock. it is crazy because that is why nurses learn dosage calculation to figure out how many mg in how many tabs or whatever.

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if you only have 250 mg tabs available than you would have to give 4 tabs to equal 1000 mg. if this was the case we would have to re write the order to reflect what mg tab is being given. crazy but state surveyors would give you a deficiency if not. i don't miss long term care a bit. lol

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I appreciate the responses. I’m also surprised At all the times on this site how unsupportive we can be. “Don’t get your panties in a bunch”, “I’m amazed you need clarification”. Please to those that can’t be nice when someone is questioning something as a nurse do not go into education. This isn’t the first time on this site that I’ve been afraid as have my nurse friends to post a question on allnurses due to getting attacked or fear our question is stupid. No question especially when giving meds to patients is stupid. We should always be questioning and clarifying with one another and the doctors. If there is even a slight instinct that something is off it should be questioned.
again thanks for the responses and we’ve had nurses giving different amounts of the same med orders because of these order so something is wrong. It wouldn’t have been dealt with had I not put my panties in a bunch.

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4 minutes ago, Mqnurse13 said:

I’m also surprised At all the times on this site how unsupportive we can be. “Don’t get your panties in a bunch”, “I’m amazed you need clarification”.

Don't worry about stuff like this. It isn't worth one second of your time. Let people say whatever they want, they don't have anything to do with you and you can't change or control that aspect of it. Life is too short to waste emotional energy in this way.

You are taking the appropriate steps, and it sounds like you did the appropriate thing in real time by clarifying with the physician--which is the most important take-away from this entire discussion.

??

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please let me apologize for my remake about being amazed by your need for clarification on this order. i meant no harm and of course no question is a stupid question especially when it comes to correct medication dosage.

again i am sorry for my statement.

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Specializes in Critical Care.
4 hours ago, juan de la cruz said:

That medication may not be available as either a 500 mg or 1000 mg tablet. There are missing elements in that prescription though. The rule for prescription writing (which still applies with current EMR systems) should read:

Drug Name 500 mg tablet, take 2 tablets by mouth twice a day.

or

Drug Name 250 mg tablet, take 2 tablets by mouth twice a day.

Those specifics should appear in medication bottles the Pharmacy prints out.

You're describing a dispensing label, which is different from a medication order or prescription.

The prescriber writes the order or prescription, then someone licensed to administer (nurse) or dispense (pharmacist) interprets the order and directs the patient how many tablets to take.

It may seem benign and I know the current trends in EMRs have blurred this distinction, but it's actually pretty important that the prescriber stay in their lane in terms of how they write the order or prescription. A large portion of the medication errors I come across share this common root cause.

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Specializes in school nurse.

I've seen something to the effect of 500 mg 2 tabs (TD = 1000 mg) twice a day written before.

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Specializes in Oceanfront Living.
On 11/22/2019 at 11:37 AM, Mqnurse13 said:

It’s long term care so there’s no pharmacy to check with. The doctor said if he writes two tabs it’s two tabs not the mg I’m just concerned with how it’s suppose to be done and if I can be liable if there is a error if I give two.

There is a pharmacy who fills the scripts. Call them and speak to the pharmacist to get their feedback.

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On 11/22/2019 at 11:37 AM, Mqnurse13 said:

It’s long term care so there’s no pharmacy to check with. The doctor said if he writes two tabs it’s two tabs not the mg I’m just concerned with how it’s suppose to be done and if I can be liable if there is a error if I give two.

Our facility policy explicitly prohibited us from entering orders this way. It was such a problem that you couldn't even enter it that way in my last facility. Only pharmacy could enter number of tablets.

I don't understand how you don't have a pharmacy. LTC uses pharmacies outside their facility, but you still use it, and they still need clarification. Lets say this is a med that comes in a 125 mg tablet. For all you or the pharmacy knows, the doctor wants two 125 mg tabs to equal 250 mg. The doctor should determine the dose, the pharmacy should determine with dose of tabs to supply.

This happens quite frequently with coumadin which has tons of different dosages. Lets say the doctor wrote 4 mg 2 tabs. (But order, but bear with me.) Ok? So is that 8mg? Lets say you have to pull from house stock as pharmacy hasn't delivered yet. And say house stock has coumadin 2 mg tabs. The order onky states 4 mg 2 tabs. If you pulled 2 tabs it would be 4 mg, not the *likely* intended 8 mg. The order is stupid. Leave the number of tabs up to pharmacy.

Another reason to leave it up to pharmacy is sometimes the price differs between say a supply of 30 scored two mg tabs vs a supply of 60 1 mg tabs for example. The doctor should state 1mg. Just an example. I do this with my propranolol. Pharmacy gives me the one that costs less, and I just break it in half as the pharmacist directs.

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