New grad-How to learn med dosing when you have tons to give?!

Posted

Hello!

I am doing a residency program and learning how to be independent on my own. However.... with 4-5 pts on med surg and each pt has like anywhere from 5-10 meds.... how do you know the appropriate dosing range while still going at a decent pace esp in the crazy morning rush?

Like what if something is normally 100mg but it was put into the computer wrong as 300mg...... I'm not going to know that 300mg is too much b/c of my inexperience!

So how do you learn? Just give it time and experience? Or look up all appropriate dosages for every single med before you clock in to work?

Thanks!

VANurse2010

VANurse2010

Has 6 years experience. 1,526 Posts

Most of us have worked in specialities long enough to know. I would suggest making a list of the most common medications on your unit and memorizing the purpose/dosages/precautions of them. Keep in mind that truly inappropriate dosages (a) are not common, and (b) the pharmacy does verify meds before they are available for you to give. this is not a justification for not knowing what you're giving, but don't think you're the only thing between a bad order and a patient, either.

Sour Lemon

Has 12 years experience. 5,016 Posts

Or look up all appropriate dosages for every single med before you clock in to work?

Thanks!

That's what you do. Eventually, you'll know most of them from experience, but until then, take the time. It's better to be accurate and a little behind than give an inappropriate medication or dose.

The good news is that most programs have RX links right on the medication screen. You can take a quick look right before you scan, and it really doesn't take much time at all.

la_chica_suerte85, BSN, RN

Specializes in Pediatric Hematology/Oncology. 1,260 Posts

In my residency, we are told to come in earlier to look everything up and see if it is appropriate. Over time (and, really, it's actually a short amount of time), things start to click and you realize what doses are appropriate or not. Ask the more experienced nurses if there is are ways to remember typical dosing ranges (i.e. I work in peds and typically we dose Benadryl 1 mg/1 kg; if we have an emergent need for Benadryl, we can just yell out, "Benadryl, 30 kilos, please!" That serves 2 purposes but I digress.) Also, a lot of times, if you're giving things that may make the patients feel funny (i.e. narcotics, benzos, antihistamines, etc.) they tend to have their own opinions on their dosages. I have a lot of parents and kids tell me how they like their IV Benadryl or Ativan and will ask before I give it how much they were ordered for and if I can run it over such and such rate. So, that helps, too, especially with meds that are the patient's home meds and with patients who give half a hoot about their medication regimen.

Meriwhen, ASN, BSN, MSN, RN

Specializes in Psych ICU, addictions. 4 Articles; 7,907 Posts

It comes with experience.

However, as a new grad, it would be wise for you to do a little homework off the clock. Make a list of your commonly used medications and their standard dose(s). While you are at it, throw in the indications, most common side effects and serious adverse effects. Use it as a study/reference tool.

And never be afraid to question a dose that doesn't look right (too large/small/frequent/whatever looks off about it).

crossingfingers10

crossingfingers10

Specializes in Hospice, ER. Has 6 years experience. 78 Posts

I second trying to spend some time learning doses for most commonly given meds. It will all come with time, I promise! You will eventually be able to recognize abnormal dosing in your sleep. However, in the mean time, study your common meds and use your resources, whether that be your fellow RNs, pharmacists, or whatever reference you have in your EMR/intranet such as Micromedex.

ArmaniX

ArmaniX, MSN, APRN

Specializes in Critical Care. Has 9 years experience. 339 Posts

(b) the pharmacy does verify meds before they are available for you to give. this is not a justification for not knowing what you're giving, but don't think you're the only thing between a bad order and a patient, either.

Tell that to the pharmacist the other night who approved an order for 20meq IV potassium qhr scheduled indefinitely.

Over time you will have a sense of what items are not the norm. Generally if any given med requires multiple pills, such as having you pull out 8 Seroquel tablets for a single order, you should question it.