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!
Specializes in Cardiac Thoracic Surgery, Emergency Med.
Well, I would have to question that order anyway... Oxycodone has tylenol in it - not less than 325mg/5mg pill. That would be 7800mg of tylenol in one day given the full dosage.
Well, I would have to question that order anyway... Oxycodone has tylenol in it - not less than 325mg/5mg pill. That would be 7800mg of tylenol in one day given the full dosage.
nope, no tylenol, in oxycodone....there IS tylenol in Percocet....
Well, I would have to question that order anyway... Oxycodone has tylenol in it - not less than 325mg/5mg pill. That would be 7800mg of tylenol in one day given the full dosage.
I think you're thinking of Percocet? I've never learned, or read anywhere of Oxycodone containing Tylenol. Percocet contains tylenol.
Our pharmacy would enter it in the system as three entries: 5, 10 and 15mg each separate entry with a 3 hour window. Were it warranted, you could give rotating doses every hour on the hour. If a nurse were brave enough, he/she could give up to 30mg at once. Granted, I'm ICU, so we are a little more liberal with our pain meds.
I wouldn't do anything but call the doctor and say I am not allowed to prescribe as that's what choosing a dose in a range is......This order could lead to every 1 hour dosing of 5 mg--talk about a mess. Nurses administer, they don't prescribe unless they are APNs.
It's a clear order. You may give up to 15 mg/3h depending on the patients response. Think about how PCA works; the patient can deliver as much med as is needed over time, so long as it is within a certain range for safety. This is a good order, IMO, as the patient can be involved in deciding what he needs for pain control.
The doctor is saying the patient can have 15mg/Q3h. I like these orders. This allows the patient to take only what they need. If they ask for a portion of the Q3h dosage and find more is needed before the 3 hour period is up, they can take up to 15mg in that time period...something like using a PCA w/o the pump. More work for the nurse, better pain control for the patient.
We don't accept orders like this unless it's a situation or trying to determine minimal effective dose for a new med. Then we use the smallest dose, and assess effectiveness; if not effective, give more (in this instance, initial dose of 5 isn't effective, give 5 more, and repeat if needed to max dose). The the trick is to figure out how much the pt need routinely (and frequency) to keep pain well controlled and follow-up with the MD for a set-dose order.
I agree with drmorton2b above, but the order needs to be clarified as soon as you know what your pt. needs.
The way we do it at the hospital I work at and most others I've been at is:
You can give 5-15 mg in 3 hours. We can start off with 5, in an hour or so give another 5 and so on. The total can't be more than 15mg in 3hours. The ortho doc's often suggest if they have ordered, say oxcodone 5mg one to two every 4 hour, to start out with one and if that doesn't cut it give one every 2 hours to keep it a little more even. Of course you could always give 2 every four, then it would be exactly that, 2 every four. It should be the total milligrams given in the alloted time.
TAB_RN
96 Posts
Well, I would have to question that order anyway... Oxycodone has tylenol in it - not less than 325mg/5mg pill. That would be 7800mg of tylenol in one day given the full dosage.