really high dose of meds . .

[anon456, BSN, RN]

This is my third post today-- I'm full of questions!

I'm a student. . . I look up meds to see what are normal doses. I had a pt who was on 2x the maximum dose of omeprazole. I asked the nurse and she said it was fine. Apparently some pts are on 4x the max dose!

I'm confused-- when does a nurse get so bothered about a med dose that they refuse to give it? They can call to ask the doctor but if he/she comfirms it, do you just give it? Where is that line drawn between following doctor orders and protecting yourself from liability?

I know it's just omeprazole, not something more serious, but it got me thinking.

[leslie :-D]

the pharmacist is your friend.:)

they should know labeled and unlabeled uses, indications and the dosages that accompany such use.

but if it's a med that reputedly carries a host of adverse/dangerous effects, it would be wise to withhold until you have experience with the specific med and situation, or reliable data to support the administration of it.

leslie

[anon456, BSN, RN]

Ah! I never thought of calling the pharmacy! Great!

[rn-jane]

Love the pharmacist. Believe me a good one will have no problem letting the doc know the dosage is exceeding the normal limits or at least let the nurse know so they can call him.

[brownbook]

Sorry, it is very confusing. You learn one dose in classrooms, the books list another dose, then a reliable doctor or nurse says an even higher dose is fine. You have to keep up with journals or reliable Internet resources. Unless you are in a code blue, or trauma case, etc., you have to stop and look up what you are not sure of. If you're really uncomfortable with a dose and a co-worker, supervisor, Dr., or pharmacist says that dose is fine you can say, "I'm really not comfortable, you give it." You also have to trust when co-workers, supervisors, Dr's or pharmacists say, "Yes, we give that dose all the time it is safe." It would be nice if they could refer you to the reference source that supports the higher dose. But you might have to trust them and look it up later.

[AmaurosisFugax]

If not supported by expert opinion or extensive publications, a statement like "we give it all the time" may not protect one from negligence if something goes wrong. It is true sometimes the maximum dose recommended by Package Insert is the max dose tested in clinical trials & higher doses are not necessarily toxic, but many times increasing the dose has no benefit but more side effects.

[AggieNurse99, BSN, RN]

I really like LexiDrugs online b/c it lists toxicity S&S so I know why the max dose is..... but remember this after you graduate: as a nurse your primary duty is to be a patient advocate. If you know something is wrong or you cannot find your employer's policy or a 'best practice' or you have a gut feeling something isn't kosher, you have a duty to your patient to reconcile the rationale and to bring it to the doctors attention and your supervisor/mgmt/etc for your patient's best interest.