BID vs q 12h

[nell]

I've got a question: Do your Docs ever write for anything to be BID, QID, 3 times/day. etc. and if they do, what time schedule do you put the med/treatment on?

The reason I am asking, is that we recently had a flap over a resp treatment ordered BID. All of us NICU people automatically think "q 12 hours". Our resp therapy dept, however, says that means 2 treatments between the hours of 8am and 10pm.

Do our RTs lack critical thinking skills or do our Docs have to write orders like they do in the adult world?

[prmenrs, RN]

An RT working in NICU should automatically change a qid order to q 6h, just like the nurse will. (Of course, the likelihood of a resp Rx being given ON TIME seems miniscule, but...that's an entirely different issue.)

Don't forget what the rationale is for giving meds during waking hours: so that the pt can be allowed to sleep at night and not have to be awakened for meds.

This rationale is not applicable in the NICU because the babies' VS, feeding, treatment, etc., all go on 24 hours/day. The babies sleep between these care-giving episodes. (Any mom can tell you babies eat, sleep, play and poop 24/7.) You're also concerned w/maintaining consistent blood levels of the drugs, babies metabolize meds differently, and so giving meds like you do to an adult might not be what's best.

This is info that is helpful to know, I hope, if you're a student, so that you can appreciate that what you learn for the general population may nor work in a specialty area. Flexibility. What they're teaching you is correct, applied to adults, not to NICU pts. As a student, it's more imp't to the general stuff, learn the specialty stuff later.

[Mofe'ny]

Respiratory is normally prett good for us, it is the hospital pharmacy. TID AC is to them 0730, 1130, and 1730 or something like that, for say reglan or something. Guess the baby is going to just reflux all night long. Whatever, we just have to fix our MARS when they print them up. I still think that you should try to get some inservices done on developmental care for the resp. dept. We had to do that with PT, and respiratory and it has really helped.

[nell]

Thanks Mofe'ny, but it was like talking to a wall to get some understanding from resp. therapy. Unfortunately, our CNS isn't any help, so the Neos are being told to write orders q12h, q6h etc. and we are to catch any slip-ups.

I glanced at the notes our medical dept. head had the other day when she was on as the Neo, and her notes were sprinkeld with BIDs and QIDs... :chuckle Just so they don't get entered into the computer ordering system that way!

The main problem with respiratory orders is that they are frequently verbal orders, and are most often modified verbally and that is where the Neos are likely to use BID or QID, etc. so we'll just have to be watchful.

?burntout and others who were being so helpful: thanks for trying. You helped me illustrate that NICU is a different world. Unless you've been there, there is no way to understand the differences. I did 10 years of adult nursing plus some newborn and light-weight level II nursery befor going to level III and was exhausted and overwhelmed on a daily basis for the first 6 months. You have to wrap your brain around some very different concepts in NICU.

[loves_xtina]

BID means twice a day. Q12 means Q12. Actually, a lot of our residents didn't realize there was a difference. From what I understand in an ICU setting BID should be spaced out Q12. TID Q8 and QID Q4 etc. On our floor we give surfak BID, but it's not like we necessarily have to follow the 09-21 schedule. I think there's just a lot of confusion with those sometimes. If they want things spaced out every so many hours then they should write q12, q4, q8, etc.

[littleneoRN]

Almost everything is ordered qxh. We only use tid, bid, etc. for meds that we want scheduled with feedings. If the doc orders it 8h and the kid feeds every three, pharmacy can modify the order to be tid so the med goes in with food. But we still space as well as possible, around the clock. So maybe midnight, 0900, and 1800. Previous posters are right that there are no such things as waking hours when you are not only in intensive care but also working with infants who are round the clock sort of creatures even when they're healthy. Why would you want to take a med four times during business hours and then not at all all night??