Medication Order

Editorial Team / Admin · Mar 9

What does facility policy state?

Nurse1282 · Mar 9

Thats the problem I cant seem to find our policy for that. Will have to ask my manager.

Been there,done that, ASN, RN · Mar 9

To me it looks like the patient can be medicated every three hours. I would have notified the physician for clarification.

toomuchbaloney · Mar 9

I'm retired now but I'll chime in.

I'd say that you need to clarify this with the ordering provider. Ranges can be interpreted or intended in slightly different ways. For instance, in hospice practice that may mean that you may medicate that patient to a max total of 2mg dilaudid in divided doses (minimum 0.5mg) no more frequently than every 3 hours. It is the provider who must provide that guidance.

I would interpret that ranged order as saying that the patient you describe could be dosed again to stay within the parameters of the order.

Okami_CCRN, BSN, RN · Mar 9

Nurse1282 said:

Dilaudid 0-5mg-2mg every 3-4hours. The nurse decide to give 1mg at 2030. Pt calls and is still in pain and wants more Dilaudid at 2200. Can the nurse give another 1mg ?

In the acute care setting this order requires clarification from the ordering provider before being carried out. Per the ISMP range orders without objective measures to determine the correct dose should be excluded from orders as it can lead to errors.

https://www.ismp.org/guidelines/standard-order-sets

Tweety, BSN, RN · Mar 11

Where I work, ranges are not allowed either in doses or frequency. Q3-4 hours is not a valid order, nor are ranges in the dose of dilaudid. Ranges require a nurse to choose and thus practice medicine without a license. So my answer is no, that once you give an ordered pain medication you can't turn around and add to it.

If there are separate orders for a pain scale for example "Dilaudid .5 mg for scale of 1-4" and another order for "Dilaudid 1 mg for 5-7", etc. Where I work if you give the lower dose, you still have to wait the time before giving another dose, otherwise you have to let the doctor know to cover yourself.

Andria McNamee · Mar 13

Acute Care in California does not allow for range order for dose or frequency. I would get it clarified ASAP.

Been there,done that, ASN, RN · Mar 13

Now I am thinking, the doctor who wrote that order was trying to prevent calls. Haha.. little did they know that it would cause more.

SnickRN BSN RN CCRN · Mar 16

I agree with Tweety. My facility used to allow ranges and then Joint updated a few things. The only time we have ranges is for drip titration.

Our facility now does a tier system for meds defined as mild, moderate or severe pain, and each with a possible first & second choice administration. Ex.: APAP for mild pain, 5-325 Norco for first choice moderate pain or 0.5mg IV hydromorphine second choice moderate pain, etc.

I would call to get a one time order for the extra dose or get a "nursing communication" order for administration of the remaining dose. Either way, CYA because you don't need a ding against you for going outside your scope of practice.

DallasRN · Mar 17

Interesting comments and variations in interpretation of the order and they all make good sense. Confirms why I'm no longer "qualified" to work acute care. "Back in the day," we would have merely titrated to eliminate the pain. Today's nurses have so much on their shoulders. The general public has no clue what nurses do or the responsibilities.

Been there,done that, ASN, RN · Mar 17

DallasRN said:

Interesting comments and variations in interpretation of the order and they all make good sense. Confirms why I'm no longer "qualified" to work acute care. "Back in the day," we would have merely titrated to eliminate the pain. Today's nurses have so much on their shoulders. The general public has no clue what nurses do or the responsibilities.

"merely triated"? I don't titrate narcs... that is prescribing.