Please interpret this med order

sasha2lady · Mar 30, 2009

i see the pts here...but if it were me...id just call the doc and get it clarified to where it made more sense b/c if it confuses you chances are it has or will confuse others....i would clarify it to say something like "oxycodone 5 mg (route) q 3 hrs prn pain. may give x mg in 1 hr if 5 mg not effective for severe pain. .......

solneeshka, BSN, RN · Apr 7, 2009

I would ask the doc to clarify the order.
Example:
Give 5mg oxycodone q3h prn if pain level 1-4
Give 10mg oxycodone q3h prn if pain level 5-7
Give 15mg oxycodone q3h prn if pain level 8-10
That's what they do at my hospital.

This is what they do at the facilities where I've been, too. Nice and straightforward! If we gave the 5 mg to start, we would not be able to go back and give more of oxycodone before the 3 hours was up, but our patients generally have orders for more than one pain med, so we would be able to give a little something of whatever else they had available.

cursedandblessed · May 29, 2009

i wish i'd had you guys after my appendectomy(ruptured, septic, open with packing and drain x 4d, iv abx x 7d). i was told i could have 5 or 10 mg q4h. 5 worked great for three hours, then the pain began, 10 knocked me on my tush for 6, but no one would get a three hour order for the 5, just kept telling me "no we can't do it that way". guess no one ever thought of advocating for their patient (me.)

Miss Kitty00 · May 29, 2009

:smokin:I am confussed, whats wrong with the order? The order reads 5-15mg of Oxycodone every three hours as needed for pain. If the patient received 5mg at noon and it was ineffective, you can give up to 15 mg of oxycodone. At 1pm or 1am you can give anther 5mg or you can give 10mg of oxycodone. The order did not say if you give 5mg at noon you cannot give any more medication for the next three hours. The ordere reads that you can give 5-15mg within that three hours.

IA, this is how we do at my hospital.

RheatherN, ASN, RN, EMT-P · May 29, 2009

i agree with the pharm poster. I work on an ortho floor and this is and EXTREMLY common order. no more than 15 in 3 hrs. then at that 3 hr mark they need to wait the 3 hrs. totally clear to me, but its something that i work with daily

-H-RR

morte, LPN, LVN · May 30, 2009

range orders are not acceptable to jcaho.....

FLArn · May 31, 2009

It depends on the setting; in hospice titration of meds is an acceptable practice. Also, it is my understanding that JACHO is an accreditation body only and does not have the authority to regulate practice.

morte, LPN, LVN · May 31, 2009

It depends on the setting; in hospice titration of meds is an acceptable practice. Also, it is my understanding that JACHO is an accreditation body only and does not have the authority to regulate practice.

hospice is a 'hole 'nother ball of wax. and titration is not a range, in the same way......giving a range like in the original is requiring the nurse to make a medical judgement. and jacho carries a lot weight.....

#1ME · Aug 7, 2011

I don't think this order is confusing at all. It is telling you, you can give up to 15 mg within a 3 hr time period. So, if you gave him one at 2100 but it doesn't relieve his pain adequately, you could give him another, and will be fine, because it wont exceed 15 mg in a 3 hr time frame.

xtxrn, ASN, RN · Aug 12, 2011

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!

With an order like that, I'd give the appropriate dose (based on patient rating of pain, vs, etc) and that be what they get for the 3 hours. I'd want a clarification order of "may repeat balance of 15mg if pain not relieved @ one hour reassessment not to exceed 15 mg in 3 hours" But then you run into when the 3 hours 'starts' counting- at the first dose, or the balance of the 15 mg????

Any way to get 5mg for pain of 1-4/10, 10 mg for 5-7/10, 15 mg for 8-10/10 q3h prn pain- then there's a consistent dose given for a consistent report of the pain level.... just an idea of a way to clearly get orders that are easier to follow