Q4-6

[Tait, MSN, RN]

Another nurse and I were just discussing this. What really is the point of putting QXhours-Xhours??

Anyone have a rationale behind this system?

Tait

[halutz_kudos]

What is Q4-6? Sorry just courious.

[catshowlady]

I would say they work to allow the nurse some discretion/judgment in adiministering. When range orders are written, you are supposed to start at the lowest dose and longest frequency. (I think it's a TJC thing. Some facilities don't allow them anymore.) So, you would start at the longest interval (q6h), and proceed to the shorter interval as needed. I usually see it in conjuction with a dose range, such as 1-2 Percocet q6-8h PRN. That gives the nurse some leeway in deciding how to best treat a pt's pain. Start off with 1 perc q8h and go from there.

I do see your point, though. They could just write q4h, since most range orders are for PRN's anyway. It's probably just a habit.

:paw:

[cardiacmadeline, RN]

At my hospital, if a doctor writes an order for q4-6 hours, pharmacy enters the order as q4 hours. To me, it really doesn't make sense to give a range of times when ordering a prn medication.

[Tait, MSN, RN]

I would say they work to allow the nurse some discretion/judgment in adiministering. When range orders are written, you are supposed to start at the lowest dose and longest frequency. (I think it's a TJC thing. Some facilities don't allow them anymore.) So, you would start at the longest interval (q6h), and proceed to the shorter interval as needed. I usually see it in conjuction with a dose range, such as 1-2 Percocet q6-8h PRN. That gives the nurse some leeway in deciding how to best treat a pt's pain. Start off with 1 perc q8h and go from there.

I do see your point, though. They could just write q4h, since most range orders are for PRN's anyway. It's probably just a habit.

:paw:

TJC?

This is kind of what we were thinking, however we weren't really taught to range it like you said (lowest, longest etc). I guess I am not sure where the common sense came from to start small and slow and then ramp up.

[WalkieTalkie, RN]

This is the way my hospital does it now too. We don't allow time ranges for PRNs any more. I think pharmacy is now calling docs at home for this type of order to get order clarifications. I don't understand the rationale of the time periods to begin with. Trust me, if my patient is wigging out, and it says Ativan 2 mg Q4-6, they're getting it Q4... duh. If I don't need to give it, no biggie.

At my hospital, if a doctor writes an order for q4-6 hours, pharmacy enters the order as q4 hours. To me, it really doesn't make sense to give a range of times when ordering a prn medication.

[catshowlady]

TJC?

quote]

The Joint Commission. They apparently don't like to be called JCAHO anymore. *shrug*

:paw:

[sethmctenn]

Doctors write orders like that appropriately all of the time for outpatients and it carries over to in the hospital.

[Tait, MSN, RN]

TJC?

quote]

The Joint Commission. They apparently don't like to be called JCAHO anymore. *shrug*

:paw:

Sometimes I think people measure progress and pat themselves on the back for completing something by basically just renaming it.

Tait

[loriangel14, RN]

What is Q4-6? Sorry just courious.

Every 4-6 hours

[Morning-glory]

I have had that discussion at work as well. It makes no sense to have it that way. Even in outpatient clinics, this would just make things more complicated than it needs to be. It was on some OTC med bottles as well. Thankfully, the doctors I work with don't use it.

[Meriwhen, ASN, BSN, MSN, RN]

How about this one: 50-100mg Vistaril q4-6h prn. Actual order I had to deal with...talk about having leeway for nursing judgements.

I hope they don't put that on the prescription when the patient leaves because they will REALLY be confused about what to take when...or they'll max it out and finish the bottle in no time.