norco limit

Specialties Rehabilitation

Published

I have a question that needs some input guys. One of the patient has an order for Norco 10-325 mg (2 tabs) to be given 5x/day. I gave the last 2 tabs for the 24 hour period. However, it pops up on the computer screen that I have exceeded the dosage. I went to check back on the computer and it was indeed the 2 pills that I have given is the last dosage equal to 5x. There were 2 tabs given around 0400, then 2 tabs around, 2 tabs around 1000, 2 tabs around 1350, 2 tabs around 1740, and the 2 tabs that I gave around 2300. That should equal 3250 mg which is the maximum dosage for the day. However, it pops up on the screen that it exceeded the maximum dosage for the day. The physician said it was ok to give it that was why he order it to be schedule in the first place. Pharmacy also said it was ok. They told me it does that because the computer somehow counts it as less than 24 hours? I'm just a little worried. I gave it anyways even though it pop up that message. It was 5x a day like the order stated, and it was scheduled.

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I would put in a note saying you verified it with the physician and pharmacy that it was OK to give that amount.

I'm curious though, as to why the patient is receiving that much Norco. I'm thinking they would benefit from a fentanyl patch instead. That just seems like an awful lot of acetaminophen.

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I would document that you clarified the order with the MD and with pharmacy and that they state it is OK to give the medicTion. Always cover your butt.

If you were still concerned for your patient you always could have called up the chain of command and clarified with as many people as made you feel comfortable until you felt that what you were doing was safe for your patient.

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Specializes in Neurosciences, stepdown, acute rehab, LTC.

Yep just document

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The recommendation for acetaminophen maximum daily dose is based upon the previous 24 hours, not calendar day. Depending on what time the dose prior to the 0400 dose was administered you might have exceeded the maximum dose for 24 hours.

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Ok I spoke with my supervisor, charge nurse and pharmacist too. The pharmacist said it was ok to give it. My supervisor is very nice. She was concern at first, but then she sawed the order and the time period as well. The doctor was also aware that was why he ordered it scheduled. I made a note of it. It says norco 10-325 mg (2 tabs) 5x day. The thing is that it was spread over every 4 hours. 0600, 1000, 1400, 1600, but the last one was scheduled for 2200. I tried to wait to wait past 1 hour after the schedule period but it stilled pop up that message. I went ahead and told the pharmacist in the morning and she told me she was aware of it as another nurse brought it up to her the previous day. This patient also has dilaudid prn meds but he doesn't take them.....

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In one hospital that I deal with the policy from pharmacy is 4 grams in 24 hours as the max acetaminophen dosage but the EHR has the maximum dose of 3 grams. Sounds like your situation may be similar.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
In one hospital that I deal with the policy from pharmacy is 4 grams in 24 hours as the max acetaminophen dosage but the EHR has the maximum dose of 3 grams. Sounds like your situation may be similar.
At my workplace, the daily acetaminophen limit from all sources was reduced from 4 grams down to 3.25 grams per 24 hour period. This change was made last year to stay in accordance with best practices.
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At my workplace, the daily acetaminophen limit from all sources was reduced from 4 grams down to 3.25 grams per 24 hour period. This change was made last year to stay in accordance with best practices.

4 grams is still the official FDA policy and the voluntary 3.25 grams has no evidence to back it up.

Confusion

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