order interpretation debate

allnurses Guide · Sep 25, 2012

Ok we had a little debate going on at work ..a doctors order was given for Dilaudid 1-2mg every 6 hours...so the nurse gave 1mg every 3 hours so as to give the drug more often but not exceed the max dose of 2mg every 6 hours...was this right?? My point was how many times does your doctor give an order like this and tell you "give the patient 1 and if it doesn't work give 2. Just wondering what you guys think?

I would clarify it with the doctor.

Mollie Jean · Sep 25, 2012

Always the best answer of course was gonna ask our clinical nurse specialist next time I work to..just found it interesting that over half the other people I talked had done that..the other half said they hadn't..just somethingg I wanted to ask a group of fellow nurses to see about how often this order is be misinterpreted

sapphire18 · Sep 26, 2012

The way she carried out the order is absolutely correct. With a range order, you can give anywhere from the minimum dose to the maximum dose during the specified amount of time. Say you have an order for 1-4 mg Ativan q1h PRN. You could give 1mg at 0800, 2mg at 0815, and 1mg at 0845. It's up to you to use your nursing judgment when given this type of order.

PediLove2147, BSN, RN · Sep 26, 2012

I had this question at work not too long ago. The answer I got was opposite of what sapphire18 said. I was told with an order of 1-2 mg Dilaudid Q6H you can give 1 mg at 7AM, 2nd mg at 10AM. You cannot give any more until 4PM, 6 hours after LAST dose. I don't really understand the rationale.. anyways, I would have clarified the order with the MD and gotten it changed to 1mg Q3H, then there is no guessing game if it is okay to give that way.

morte, LPN, LVN · Sep 26, 2012

if this order is IV, it is totally inappropriate to begin with. The half life of Dilaudid is too short. Not sure on PO. I wouldn't have thought to do it her way, but it makes sense, d/t the half life issue. Need better order.

PediLove2147, BSN, RN · Sep 27, 2012

I had this question at work not too long ago. The answer I got was opposite of what sapphire18 said. I was told with an order of 1-2 mg Dilaudid Q6H you can give 1 mg at 7AM, 2nd mg at 10AM. You cannot give any more until 4PM, 6 hours after LAST dose. I don't really understand the rationale.. anyways, I would have clarified the order with the MD and gotten it changed to 1mg Q3H, then there is no guessing game if it is okay to give that way.

I rechecked with some people I work with and I was mistaken. You can give the 1mg Q3H. It's when you give 1mg at 7AM then 1mg at 10AM and want to give the full 2mg again at 1PM. You COULD give the 1mg just not the two. So while I would still check with the MD, what your co-worker was doing wasn't wrong.