qWeek vs q7days?

[jdsp87]

Hello, I work in an [outpatient skilled nursing] Adult Day Care. I have a patient with renal insufficiency receiving Procrit sq injections ordered "qWeek". He received an injection last Friday and came in today for another (Thursday) because he said he would not be coming in tomorrow. My co-worker RN stated "We cannot give it to you today. It must be tomorrow or later."

Now I've only been an RN for a year but I think we can give it any day of the week, as long as there has not been a previous injection the same week. If the MD meant for it to be only for tomorrow (Friday), wouldn't he have written "q7days"?

I've tried explaining to my co-worker that Procrit is important and he might not be able to wait until next week, but I always get the "Doctor said one week exactly. We must follow what the doctor said because it's our license."

I need some help! There IS a difference between qWeek and q7days right?

[Pepper The Cat, BSN, RN]

I think your co-worker is right. A week is 7 days. So you need to wait at least 7 days.

Using your logic, if he received it Friday, you could give it again Monday because its a different week.

In this case, I would probably check with the doctor. Maybe you can give it 1 day early. I'm not familar with this drug, so I don't know.

[brownbook]

All I know about procrit is it is a complex drug with complex interactions and side effects.

If the patient has been on procrit for quite some time, has been stable, tolerating it well, if the patient is alert, competent, knows and manages their health needs (or their primary care giver does), I would give it. Maybe if you could easily quickly contact the patient's doctor that would be nice but if it would be hard to get a hold of the doctor I would give the procrit with no qualms.

Q week and Q seven days can be confusing. But the implication is Q week means Q seven days. You have raised a good issue of an unsafe written order.

[Reno1978, BSN, RN]

No, there is no difference between 1 week and 7 days. We're talking about medications here. If the provider wanted the patient to take something once per week, it would be the same day each week.

I agree with your co-worker that the dose would be early. HOWEVER, knowing that he is going to miss his weekly dose the following day, I would have asked the patient when he would be able to arrive to receive his next dose, and then I would have phoned the provider to ask if it would be acceptable to give the dose early or if it would have been okay for the patient to wait.

The medication guide for this drug advises patients to phone their provider and ask what to do if they miss a dose.

[Meriwhen, ASN, BSN, MSN, RN]

Q week means a week between doses.

Q7 days means seven days between doses.

Basically, there's no real difference.

[wooh, BSN, RN]

I think there are is a difference. Like Qday and Q24 are different. I'm not saying, he could have it on Saturday one week and Sunday (the very next day) for the next week. Go for as close as 7 days as possible. But how likely is it, that this fantastic drug really needs to be dosed exactly 168 hours apart? That they did testing and 6 days was too close but 8 days was too long? I'm betting weekly was chosen because it's easily remembered.

Check with a pharmacist to be sure, (and if you feel it necessary, with the MD to cover yourself, I wouldn't if I had pharmacy saying it was good to go), but if I had a pharmacist say it's ok, and I'm betting it is, I'd give it on day 6.

[evolvingrn, BSN, RN]

I would have called the dr and just gotten an okay to give it a day early. That way pt is happy, your covered ect... easy fix. :)

[himilayaneyes]

That order is definitely unsafe. Better for the doc to write every Friday vs q week (when in the week). There's potential for confusion which JCAHO wouldn't be happy about. However, the patient needs his medication. I hope that you or the other nurse called the doctor for order clarification so the patient will be covered.

[caliotter3]

I certainly would have called the doctor for instructions.

[merlee]

A better order might read 'give weekly on Friday. May be given +/- 1 day if necessary'

This covers you if your office might be closed due to a legal holiday, pt needs to be somewhere, etc.

Procrit helps the body manufacture blood cells. Dialysis patients usually get it on the same day every week.

[NamasteNurse, BSN, RN]

That order is definitely unsafe. Better for the doc to write every Friday vs q week (when in the week). There's potential for confusion which JCAHO wouldn't be happy about. However, the patient needs his medication. I hope that you or the other nurse called the doctor for order clarification so the patient will be covered.

I give several pts procrit and it's always written every Friday at 9PM or whatever, but an exact day and time.