Ok for whatever reason, my pt has vicoden instead of percocet ordered. Q4h prn pain. So she wanted it round the clock since yesterday. I got her today. I got the first dose about five hours after her last dose, and another nurse gave her the next dose 4h later at my request since I was admitting another patient at the time.
So the nurse coming on after me tells me that there is too much tylenol in Vicoden to give q4 and that it should be q6h.
I am new enough to not have known. And I was told by the previous nurse (who is also an upper level nurse) that she wants it q4 and to give it that way. (Pt kept track and asked for meds, didn't automatically bring them in)
So what the heck...the order was over a day old, and no one said anything about too much tylenol before this. I am GLAD the nurse mentioned this, as I did not know it. I know that vicodin has tylenol, but I never dreamed that it was too much.
I am having trouble knowing what I should know, and not knowing htat I should know something that I don't know! Do I have to look up EVERY medication that is ordered? I always look up the ones I don't know, but the problem is that I thought I knew vicodin.
I didn't think to question the order because I didn't know I should question it.
I *thought* I knew vicoden, I was wrong I guess.
I call the pharmacy at the drop of a hat, with any medicine question, its not like I don't pay attention. I just plain didn't know.
I know I am at fault for not knowing and for not looking it up--but if I don't know, how do I know to look it up?
I am thinking of requesting that there be a protocol that ALL vicoden orders be standard at q6 unless there are special circumstances, or that each vicoden order clearly states the max dose.
anyway, I hate leaving work with that as the last thing done.
You have to be careful with doctor's orders. Many follow them blindly. Our docs used to write for 1-2 Tylox, 1-2 Fioricet and 1-2 Tylenol all Q4-6. And guess what lots of our nurses would give them all because they weren't thinking of toxicity. They just wanted to get the screaming neuro pt off of their back. Luckily, I don't think we turned too many of them into liver pts.
Oh yes blindly is right. I had an RN who gave 20 of MS IM and then 20 mins later gave another 10 because patient's family complained he hurt. Narcan and more Narcan....spooky and scarey.
don't worry. eventually you'll learn the rules about the meds most common to your unit. you can't be expected to know everything (although sometimes it might seem like you are), but you'll quickly learn the common ones.
Ok for whatever reason, my pt has vicoden instead of percocet ordered. Q4h prn pain. So she wanted it round the clock since yesterday. I got her today. I got the first dose about five hours after her last dose, and another nurse gave her the next dose 4h later at my request since I was admitting another patient at the time.
So the nurse coming on after me tells me that there is too much tylenol in Vicoden to give q4 and that it should be q6h.
I am new enough to not have known. And I was told by the previous nurse (who is also an upper level nurse) that she wants it q4 and to give it that way. (Pt kept track and asked for meds, didn't automatically bring them in)
So what the heck...the order was over a day old, and no one said anything about too much tylenol before this. I am GLAD the nurse mentioned this, as I did not know it. I know that vicodin has tylenol, but I never dreamed that it was too much.
I am having trouble knowing what I should know, and not knowing htat I should know something that I don't know! Do I have to look up EVERY medication that is ordered? I always look up the ones I don't know, but the problem is that I thought I knew vicodin.
I didn't think to question the order because I didn't know I should question it.
I *thought* I knew vicoden, I was wrong I guess.
I call the pharmacy at the drop of a hat, with any medicine question, its not like I don't pay attention. I just plain didn't know.
I know I am at fault for not knowing and for not looking it up--but if I don't know, how do I know to look it up?
I am thinking of requesting that there be a protocol that ALL vicoden orders be standard at q6 unless there are special circumstances, or that each vicoden order clearly states the max dose.
anyway, I hate leaving work with that as the last thing done.
Sorry I didn't see where it explicitly said 2t po q4h atc prn pain..... Maybe I misread.
Specializes in Education, Acute, Med/Surg, Tele, etc.
Our hospital protocol, 3000mg acetaminophen daily...that includes anything with acetaminophen.
What was kinda cool was one place I worked in had a tally on their pixis systems and would tell you how much more the patient could have in a 24 hour period so you could check. It blinked up before you could even take the med out...so you could make choices dependant on how much longer the 24 hours was, or if you thought maybe another choice till such and such could be used...nice handy trick!
In the pixis I have now, I can do a check to see how much has been given in 24 hours, but it is a separate process. So I use that and the MAR to calculate when I think the max is approaching :).
You are either supposed to know it or know how to reference it. If you do not take time to reference then you are putting your license, and your patient, at risk.
anc33
327 Posts
You have to be careful with doctor's orders. Many follow them blindly. Our docs used to write for 1-2 Tylox, 1-2 Fioricet and 1-2 Tylenol all Q4-6. And guess what lots of our nurses would give them all because they weren't thinking of toxicity. They just wanted to get the screaming neuro pt off of their back. Luckily, I don't think we turned too many of them into liver pts.