Patient wants to split doses of pain meds

agldragonRN · Apr 19, 2009

she wants one pill every two hours instead of two pills every four hours. i don't mind it, but i explained to her that this is kind of a gray area and some nurses would not do this as it technically is illegal. (the doctor's order is 1-2 pills every 4-6 hours.) then it occurred to me that i don't really know if it is! so, what do you all think?

why don't you just get the order change to one pill every two hours? tell doctor it is per pt request.

personally, i would not do what you do as the order says 2 pills every four hours. i don't see any "every 2 hours" in the doctor's order.

focusedvalpn · Apr 19, 2009

She wants one pill every two hours instead of two pills every four hours. I don't mind it, but I explained to her that this is kind of a gray area and some nurses would not do this as it technically is illegal. (The doctor's order is 1-2 pills every 4-6 hours.) Then it occurred to me that I don't really know if it is! So, what do you all think?

my :twocents: would be that technically the order is wrong in its self at least in va from what i have been told. we had a state inspection at a ltcf and we were sited for orders that were incorrect. the order has to be specific it should either be one pill Q 4 HR or two pills Q 6 HR. if i were you i would just get a clarification order and be done with it because if she tells someone that you are giving her a pain pill Q two hrs it will be more trouble than it is worth in my opinion especially when all you had to do was clarify it:specs:.

Virgo_RN, BSN, RN · Apr 19, 2009

Medication orders with dosage ranges are designed to give a certain amount of flexibility to customize dosing for the individual patient. These types of orders are not illegal in my state, and they are frequently used at my facility which is JC compliant.

Another aspect of this is that a pain pill every two hours is not really the best use of the pain medication or the nurse's time. If the patient needs dosing that frequently in order to keep their pain under control, it might be beneficial to try something stronger so they won't need it as often, or to look at an extended release medication that can be given once or twice a day. It really depends upon the nature of the pain, i.e. whether it is acute or chronic, or acute on chronic.

lpnflorida · Apr 19, 2009

I would give the 1 pill every 2 hours as the patient requests

. Some patients are fearful of taking 2 pills at once as they fear it may be too strong for them. For some they get better pain control taking it every two hours. There really is no contraindication for taking it as two pills in set amount of time at once versus 1 pill at a time. The important thing it to not exceed dosage in said time period.

Talk it over with her doctor. Our pharmacy automatically calls the doctors and change the times to the least amount of time, so actually the six hour time limit would be a moot point. Our doctors are getting much better about writing orders with that type of time span as they have learned it will be changed anyway.

Vito Andolini · Apr 19, 2009

I would give the 1 pill every 2 hours as the patient requests
. Some patients are fearful of taking 2 pills at once as they fear it may be too strong for them. For some they get better pain control taking it every two hours. There really is no contraindication for taking it as two pills in set amount of time at once versus 1 pill at a time. The important thing it to not exceed dosage in said time period.

OP should get a new order, though, to avoid grief and questions down the road when it is discovered (and it will be) that she is giving a pill q2h instead of q4h. Also, I'm not the best mathematician in town but

a pill q2 = 12 per 24h and q4 = 6 pills per 24 hours. Doesn't it?

actually, I just re-read the OP. Never mind.

April, RN, BSN, RN · Apr 19, 2009

I agree with talking to the doctor and either having the order changed to 1 tab q2h or switching to a different medication. It just doesn't seem to be an effective method of pain control for the patient or the nurse to be giving one pill every 2 hours.

Cobweb · Apr 19, 2009

Well, I don't think it's about pain control; I think it's about control, period, hehe. She's been here less than 24 hours and already my CNAs are calling her "Princess" and not in a nice way.

I just couldn't remember if this is legal or just my perception, but seems the votes are pretty split here also. I was gonna throw her pain control issues to the doctor this morning, anyway; I just wanted to know for myself. Thanks though!

zoopnever · Apr 19, 2009

We can give less than the prescribed pain meds, up to the prescribed dose. for instance the order is for Dilaudid one mg every 2 hours. I can give you a half mg now and a half mg in an hour, for a total of one mg in that 2 hour time frame. I just can't give you more. That's not a grey area as far as I know; it's the way I was taught and I've been doing that for ten long wonderful years now.

diane227, LPN, RN · Apr 19, 2009

If she wants one every two hours, that is fine with me. It actually might be better for her to help her keep her pain under a more constant control. As long as you don't go outside the ordered parameters, I think it is find. None of the docs that I work with would care on way or the other.

ImMrBill3, RN · Apr 19, 2009

I was wondering what you all would think of asking the charge nurse in this situation. I know asking for clarification orders can incur the wrath of the mighty MDs if not needed. Why not ask the charge and then follow his/her instructions. Where I have done my clinicals we have to document time of meds if giving every two hours is wrong I would be concerned when charting.

caliotter3 · Apr 19, 2009

You can't go wrong by getting a doctor's order to coincide with the patient's wishes, or better yet, get an order for a more effective pain regimen. Avoid trouble and speak to the doctor about this.