Please interpret this med order

[Jennabugs]

I had some controversy at work last night, and our pharmacist was going to look into our hospital policy, but in the mean time...

Your order reads "Oxycodone 5-15mg po Q3 hrs prn pain". How do you interpret? I interpret this to mean the patient may receive 5mg say at noon, if that does not work, they may receive up to 10mg more for a total of 15 within that three hour period. Then they may not have more until that three hour period is up.

My colleage says that is incorrect, you may give 5-15mg at noon, if not effecitve, you must wait the full three hours to give more, even if you only gave 5mg.

Can anyone give their opinion? I would much appreciate as I have always dosed this way and now am worried I have been making med errors!

[UM Review RN, ASN, RN]

I've done it your way. Sometimes the patient will be just fine with the lower dose, other times, if pain is unrelieved, a little more helps.

The choice in dosages to me presumes that the doc is OK with up to a certain amount based on our nursing judgment.

[drmorton2b]

"Oxycodone 5-15mg po Q3 hrs prn pain"

Not to exceed more then 15 MG in 3 hours

Thats from a pharmacy point of view.

[chare]

I agree with your colleague and her/his interpretation of the order. You can administer 1 dose of 5 - 15 mg based upon assessment findings and patient's complaint of pain every 3 hours.

However, the determining factor is going to be what your hospital's policies and procedures dictate.

[queenjean]

We do it *your* way at our hospital, with the key factor being that, if you first gave 5 mg at noon, and then at one gave 10 mg, the pt wouldn't be able to have any more until four (three hours after last dose), and you bet next time I'd give the full 15mg.

I suppose it depends upon your facility. I know that if I gave 5 mg, and then called to get an order for more, any of our docs would not be pleased, their response would be -- give the other 10mg and why exactly did you call me on this?

[grad*student]

"Oxycodone 5-15mg po Q3 hrs prn pain"

Not to exceed more then 15 MG in 3 hours

Thats from a pharmacy point of view.

This is how I interpret it, and how the docs on an ortho floor where I used to work interpreted it. We would always offer the pt 5-10 mg first, but let them know that more medicine was available if they needed it for pain control. Thus, a pt could always request an additional 5mg if needed prior to the 3 hrs running out. In this manner, patients actually took LESS medication than they would if you could only administer it every 3 hrs according to the clock (for if they had to wait the entire 3 hrs, most pts would just ask for the entire 15 mg at once, which could cause extreme lethargy in some). It was safer to have this range, and nurses used their professional judgement.

[meandragonbrett]

I say you can give 5-15mg at noon based on assessment, but then you cannot give anymore for 3 hours. On the other hand, if it was written "percocet 5-15mg q2-3 hours" that would be a whole different story.....but most hospitals have banned orders with hour ranges. I most commonly see "percocet 1-2 tabs q4h PRN"

[CoffeeRTC, BSN, RN]

Thankfully, LTC regs do not allow this type of order.

[FLArn]

In the hospice setting the use of that order would be no more than 15 mg in any 3 hr period . i.e. 5mg @ 12N no more than a total of 15 mg by 3pm

[GLORIAmunchkin72]

Orders should be clear and unimbiguous.

[FLArn]

That order is perfectly clear if you are a hospice nurse as we are permitted to titrate meds to acheive symptom control. You start with the lowest dose and titrate up until you have controlled the symptom. You just have to keep track of what you've given at what time so you don't exceed the maximum dose ordered within any rolling time period. (e.g 0.5 - 2 ml Roxanol q 2 hr prn if 0.5ml given at 2:00 pm - no more than 2ml given before 4:00 pm)

[lil' girl, LPN]

Orders should be clear and unimbiguous.

Yep! They tell us to write um so that a third grader can read and understand.