Administer medication right or wrong - page 2

Question: When administering a medication according to Mar. For example if you need to administer a quarter of a pill should the Mar read. Give 0.25mg or 0.5mg of pill and should the mar have the... Read More

  1. by   GaryRay
    At the end of the day, the dose is the mg ordered
    they could have just written Ativan 0.5 mg po bid and called it a day just make sure you document you have a 2mg tablet and you waisted 1.5mg

    I think only outpatient pharmacies write it with the half or quarter tablet on there and that is just because they are required to first identify what the actual tablet is (ativan 2mg tablet) then the doctor's order (0.5mg) but they like to dumb it down for the lay person so they write the "give a quarter tablet twice a day"

    Tell your doctor to decrease med errors and order 0.5mg tablets.... just sayin
  2. by   Neats
    OMG this is a prime example why we need standardization and why so many medication errors are out there
    You wrote
    When administering a medication according to Mar. For example if you need to administer a quarter of a pill should the Mar read. Give 0.25mg or 0.5mg of pill and should the mar have the Dose of the medication you're getting the quarter from.
    Which is right or are both of them wrong?

    Ativan 2mg
    Give 0.5 mg PO bid.

    Ativan
    Give 0.5mg PO BID.

    I was told that you give whatever is on hand.
    What is the order? Ativan 0.25 mg?
    Ativan 0.5 mg?
    Ativan 2 mg?

    I get the twice daily...BID.
    Both are wrong.

    The example of what you said above administer a quarter of a pill...this is too objective get tighter parameters you will have a medication error. You are trying to interrupt what someone wrote, get clarification.

    THE MAR SHOULD HAVE THE ORDERED AMOUNT OF MEDICATION, after this what you have on hand you need to calculate. example a provider ordered Ativan 1 mg BID-- (equals 2 mg over a 24 hour period of time). You have on hand Ativan 2 mg you would cut (score) the 2 mg in half and give half a pill in morning and the other half in evening for a total of (2 mg over a 24 hour period of time). Document on back of MAR you gave 1 mg at 0800 and then documentation should show another 1 mg at 2000 hrs 1 mg (total of 2 mg BID)

    A better order written is: Ativan 1 mg in morning and Ativan 1 mg in evening.

    First NEVER, NEVER NEVER give a medication without clearly understanding the order. NEVER NEVER NEVER give medication that is cut so much you have to give it in quarter increments...this is the pharmacy job, if they cannot do this then I suggest you have the pharmacists speak with the ordering provider. If I am cutting a scorable medication in half this is one thing but to do so again to get a fourth of a tablet... this is another issue I do not want on my license.

    If the order is for a different dose amounts then get parameters for this order: give Ativan 0.25 mg BID, if patient continues with symptoms allow for additional 0.25 mg after 2 hours...not to exceed 1mg over a 24 hour period.(just example). If you are giving medication you should at least be able to look up the medication for dose amounts, this medication comes in 0.5 mg, 1 mg, and 2 mg tablet forms. I do think the 0.5 mg is scorable meaning you can cut it in half to get your 0.25 mg dose. I try not to make it a practice to cut any medication and if the pharmacy can do this I want them to just to ensure the patient is getting all medication they need, particular for seizure use.

    Lastly if this is for home work take this as lessons learned in that it is up to you to ensure the order is written in a simple understand way for all the answers that were rendered as you can see causes confusion. Confusion over medication is not something you want to experience you are the one who is administering this.

    Good on you for not giving what the parents told you to give...now go back and educate, educate, educate.
  3. by   MunoRN
    Medication orders should express the ordered dose, not a math calculation that will lead you to the correct dose, and should not contain any values that could be confused for the dose, such as 0.25 (or 1/4) of a 2mg dose. The "2mg" part is not the ordered dose but could be confused for the ordered dose, and that order does not contain the actual ordered dose, 0.5mg, anywhere in the order. The physician is free to clarify the preferred dispensed unit size, but it should not be a part of the order itself. Of course it's different when a medication is dispensed by a pharmacist, since the pharmacist interprets the order and puts instructions on the medication label, nurses however utilize physician orders directly.
  4. by   smartnurse1982
    Quote from GaryRay
    At the end of the day, the dose is the mg ordered
    they could have just written Ativan 0.5 mg po bid and called it a day just make sure you document you have a 2mg tablet and you waisted 1.5mg

    I think only outpatient pharmacies write it with the half or quarter tablet on there and that is just because they are required to first identify what the actual tablet is (ativan 2mg tablet) then the doctor's order (0.5mg) but they like to dumb it down for the lay person so they write the "give a quarter tablet twice a day"

    Tell your doctor to decrease med errors and order 0.5mg tablets.... just sayin
    Parents and supervisor will chew you out if you put "wasted medication".
  5. by   caliotter3
    Quote from heron
    In my facility, it would be written:

    Ativan 2mg tab, give 1/4 tab (0.5 mg) po BID
    We use this example reversing putting the dose (0.5 mg) outside of the () and the amount/volume is placed inside the parentheses. The dose does not change. The amount/volume could change based upon the strength of what is provided.
  6. by   KelRN215
    The order should simply state the dose in mg since the pharmacy could change the tablet strength at any time d/t product availability.

    Ativan 0.5 mg is in no way ambiguous. Regardless of the tablets dispensed are 0.5 mg, 1 mg or 2 mg, you need to give 0.5 mg. Putting 1/4 tablet on the MAR could lead to med errors if the next dispense is 0.5 mg tablets.

    At my last job, we did once have a Mom underdosing tobra nebs because the Pharmacy had a different concentration than the hospital did and the hospital put the dose on the discharge paperwork in mL instead of mg. It was something like commercially available Tobi nebs are available in 60 mg/mL but only in 5 mL ampules and the standard dose is the full 5 mL/300 mg for adults and children over 6. This child was 2 so couldn't get that formulation so we were providing IV tobra for inhalation. Our IV tobra concentration was 40 mg/mL. Even though the pharmacy labeled it as such and provided written instructions to administer 2.5 mL for the child's 100 mg dose, the mother followed the instructions on the discharge summary and gave 1.67 mL. The Pharmacy figured it out when the Mom called asking for smaller syringes and they asked her why she needed smaller ones. When the NP asked me how to avoid issues like this in the future, I told her "only write the orders in mg and let the Pharmacy take care of the instructions in mL." She didn't like that answer.

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