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!

1 hour ago, beachbabe86 said:

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

Yep, and if the prescriber is giving you a hassle with changing the way the orders are written, the pharmacist can call and talk to the doctor.

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See this all the time, and I have caught a few medication errors because of this...

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14 hours ago, gooodnitenurse said:

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.

I'm amazed that you don't see the issue with the way the order is written. Would I interpret it to mean 1000 mg? Probably. But an order should not be interpreted. It should be direct. The order is for 1000 mg. Tbe order should read 1000 mg. Maybe your facility does it that way, but my last facility did it the exact opposite and completely prohibited us from entering the number of tabs for the very reason there are so many differing opinions on this post. Clearly enough orders such as this have led to med errors considering safeguards were implemented to not even allow us to enter it this way in our emar.

14 hours ago, gooodnitenurse said:

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.

I'm amazed that you don't see the issue with the way the order is written. Would I interpret it to mean 1000 mg? Probably. But an order should not be interpreted. It should be direct. The order is for 1000 mg. Tbe order should read 1000 mg. Maybe your facility does it that way, but my last facility did it the exact opposite and completely prohibited us from entering the number of tabs for the very reason there are so many differing opinions on this post. Clearly enough orders such as this have led to med errors considering safeguards were implemented to not even allow us to enter it this way in our emar.

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14 hours ago, JKL33 said:

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.

??

The problem is certain attitudes dissuade some who have questions from even posting here. Questions, that if left unasked, could lead to harm.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.
11 hours ago, MunoRN said:

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.

That's not true. The prescriber must write the order in the same way the Pharmacist fills it. That's basics of Pharmacology for providers. Based on the OP's post, I got the impression that the "facility" is not a hospital and so the orders must read as it does if a patient is at home.

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2 minutes ago, juan de la cruz said:

That's not true. The prescriber must write the order in the same way the Pharmacist fills it. That's basics of Pharmacology for providers. Based on the OP's post, I got the impression that the "facility" is not a hospital and so the orders must read as it does if a patient is at home.

Incorrect. How is the prescriber to know 100% of the time how the pharmacy chooses to dispense the drug? If an order is for 40 mg and the pharmacy is in on back order for 40 mg tabs, the pharmacy can choose to dispense 20 mg tabs and direct you to take 2 tabs.

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Specializes in Critical Care.
26 minutes ago, juan de la cruz said:

That's not true. The prescriber must write the order in the same way the Pharmacist fills it. That's basics of Pharmacology for providers. Based on the OP's post, I got the impression that the "facility" is not a hospital and so the orders must read as it does if a patient is at home.

That's not a requirement or an appropriate prescribing practice. The point in the process where the determination of the number of tablets to take and communication of that to the patient occurs in either the administration or dispensing, where it's determined by the stock on hand or preferred form. If the prescriber for some reason has a specific preference as to the tablet size, it should be written as "acetaminophen PO 1000mg q6hrs. Dispense as 500mg tablets". An order or prescription written as "500mg take 2 tablets" does not include the correct dose of 1000mg anywhere in the order, and instead includes an incorrect dosage distractor, which is a poorly written order.

Where I see this most commonly is where a prescriber thinks they're being helpful by writing a script for 25mg metoprolol as 50mg, take one-half tab, to try and save their insurance-less patient money, not realizing they are most likely going to use the commonly available $4-for-a-month supply options, in which case the prescriber is going to fill the script as 25mg tabs, but the prescriber jumped ahead in the process and already told the patient to take a half-tab, so now they are taking half a 25mg tab. And then when the patient comes into the hospital, med recs often format the PTA orders as an initial section for dose, which would in this case be 50mg, and then somewhat obscured in the comments section it says "take one half tab", these orders will be frequently misread and the patient will have their home med ordered as 50mg while in the hospital.

There's no reason to not write the initial order with the correct dose prominently included, and no reason to jump ahead and try and do the administering or dispensing step of the process at the same time as the prescribing or ordering step.

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1 hour ago, Orion81RN said:

The problem is certain attitudes dissuade some who have questions from even posting here. Questions, that if left unasked, could lead to harm.

I hear you--but that's precisely why it's imperative to rise above. Best to realize others' poor behaviors say nothing about us personally and aren't about us, they're that person's problem solely.

Neither of the positions (snarkiness or avoidance due to snarkiness) are defensible IRL, because at the end of the day the patient has to remain safe one way or the other. The mean or sarcastic one won't be the one who will be said to have harmed the patient and won't be the one who gets in trouble when I have failed to clarify something someone else thought was clear. I've always told myself "what's the worst that can reasonably be expected to happen?">>Someone yells at me or delivers what they believe is some kind of insult. ??‍♀️ Okay. You know? They can go bother someone who cares about that kind of stuff.

[There are situations where the ramifications might be more than "just" snarky words...like reporting or trying to get the nurse written up, or otherwise causing real trouble. Those are not places one should work and are beyond the scope of what I'm trying to say.]

This is not a critique of the OP, I'm only writing it as some kind of encouragement. ? It's really rather freeing and empowering to realize that we don't have to be controlled by this.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

From: Prescription Writing 101 (with Example Prescriptions)

https://medicalschoolhq.net/prescription-writing-101/

Quote

How to Write a Prescription in 4 Parts

  1. Patient’s name and another identifier, usually date of birth.
  2. Medication and strength, amount to be taken, route by which it is to be taken, and frequency.
  3. Amount to be given at the pharmacy and number of refills.
  4. Signature and physician identifiers like NPI or DEA numbers.

Medication order ( 500mg, 2tabs, twice a day) meets #2 of above standards:

Medication name, strength= 500mg, amount to be taken = 2 tabs, needs route = oral ( suspect Dr. assuming that tablets taken orally), frequency= 2x day .

That's how I was taught to interpret medication orders and have done so for 40+ years, especially in last home health positions as Central Intake Mgr. + Quality assurance reviewing thousands of medication orders weekly.

When interpreting it may be helpful to add "take" after dose listed

(500mg, take 2 tabs, twice a day). Additionally, nurse needs to consider if medication being prescribed + dosage written is usual standard for that medication along with used for patients diagnosis

Years ago, I prevented medication error in report told that doctor wanted med given STAT and order hand delivered to pharmacy--- old school med written as Aldomet 300mg IV Q6 hrs for patient with suspected GI bleed.

BP was 130/70 (WNL, Aldomet not indicated for client without HTN DX, usual dose dose Aldomet 250mg or 500mg, never seen 300mg dose). So called Doc--he meant to write for Tagamet, he came to floor rewrote order.

In LTC setting, I'd check med bottle + query pharmacist who dispensed med, otherwise call doctor for clarification.

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Specializes in Critical Care.
3 hours ago, NRSKarenRN said:

From: Prescription Writing 101 (with Example Prescriptions)

https://medicalschoolhq.net/prescription-writing-101/

Medication order ( 500mg, 2tabs, twice a day) meets #2 of above standards:

Medication name, strength= 500mg, amount to be taken = 2 tabs, needs route = oral ( suspect Dr. assuming that tablets taken orally), frequency= 2x day .

That's how I was taught to interpret medication orders and have done so for 40+ years, especially in last home health positions as Central Intake Mgr. + Quality assurance reviewing thousands of medication orders weekly.

When interpreting it may be helpful to add "take" after dose listed

(500mg, take 2 tabs, twice a day). Additionally, nurse needs to consider if medication being prescribed + dosage written is usual standard for that medication along with used for patients diagnosis

Years ago, I prevented medication error in report told that doctor wanted med given STAT and order hand delivered to pharmacy--- old school med written as Aldomet 300mg IV Q6 hrs for patient with suspected GI bleed.

BP was 130/70 (WNL, Aldomet not indicated for client without HTN DX, usual dose dose Aldomet 250mg or 500mg, never seen 300mg dose). So called Doc--he meant to write for Tagamet, he came to floor rewrote order.

In LTC setting, I'd check med bottle + query pharmacist who dispensed med, otherwise call doctor for clarification.

I'm not sure that medicalschoolhq.net is an established source of prescribing standards, or really anything, but even that post points out that the only part of the order that really matters is the actual dose, any reference to a number of tabs will be changed as necessary, so it's fairly pointless to include and only adds irrelevant distractors to the order. It's the same distractors we add to nursing school tests to trip them up.

I won't argue that even more reliable sources might teach this bad habit to prescribers, but just because a bad habit is firmly entrenched doesn't mean it's not a bad habit.

There is no benefit and a long list of safety risks with writing an order or prescription this way, if someone has an argument for why it's actually preferable I'm open to it.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

NY state has guideline for Preventing Prescribing Errors:

https://www.health.ny.gov/publications/1418.pdf

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Specializes in School Nursing.
On 11/22/2019 at 9:24 PM, hherrn said:

I think it's weird that you are asking whether or not you will get in trouble.

How would you get in trouble for giving a patient the correct medication?

I don't think it's weird at all. I think that the person is just trying to get advice from more experienced nurses. I think that's what this site is all about. I don't think it's right to respond to her posting so disrespectfully. We should be helping and supporting each other, not knocking each otther down. Thank you.

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