Prescription PO/Subcut

[Sjade]

Hello,

I am a nursing student and have noticed on the palliative care ward I am on has a way of prescribing that I'm not sure on.

For example a PRN dose of ondansetron for nausea and for the route they write PO/subcut.

My understanding however is that an oral dose would not be equivalent to a subcut dose?

I am right to believe that and where could I find more info on this?

Should these be charted separately for example:

Ondansetron subcut Xmg Q3hrs blah blah

Ondansetron PO Xmg Q3hrs blah blah

Also, while trying to find info on this I came across that ondansetron doesnt seem to be commonly given as a subcut injection rather an infusion in pall care?

Does anyone have any evidence on best evidence practice for administering it?

Obviously in nauseated pts PO isnt very feasible..

Thanks in advance.

[blondy2061h, MSN, RN]

Are you seeing it mostly with Zofran or other meds too? Zofran dosing is the same regardless of route- usually 4 or 8mg. I'm guessing the reasoning here is that the palliative patients don't have IV access and they want them to be able to have it subq if they can't tolerate PO, or PO if they can and want to avoid the injection. Keeping it on the same order prevents it from being given too frequently with combined subq and PO doses. I'm sure the way TJC would want it would be 2 separate orders with a comment not to administer within 6 hours of each other.

This is, of course, all speculation to what the prescriber was thinking.

[Tenebrae, BSN, RN]

Cant speak for the prescriber.

We often ask the doctor to chart subcut as well as oral with palliative patient, its helpful when the patient isnt tolerating oral medications, or not getting adequate benefit from oral medications we can change the route without having to wait for the doctor to change the order (work in aged care and doctors arent always on sight). The preference for subcut over IV is that a subcut line will last for a lot longer, they can stay on for up to 7-10 days where as usually the maximum time for an IV line is 72 hours.

Subcut also has less risk of complications than IV route, and for someone who is dying comfort with as few complications as possible is paramount.

Depends on the medication in terms of dosage. For example morphine when changing from oral to subcut for a syringe driver the dose is halved. eg mum was taking 140mg orally a day so when she was put onto a pump that was halved. Also with morphine we would have two seperate orders, one for oral and one for subcut

Hope that makes sense

[AusSRN]

You've answered my question to a T. Thank you very much for your time!