Roxanol Dosage Error?

[stdntograd06, BSN, RN]

There is a resident where I work who is on Hospice. This is what Hospice wrote for her:

Roxanol 0.5MG/0.25mL Q4hrs. PO/SL for anxiety/SOB.

What is supplied is:

Roxanol 20MG/1mL

I believe they wanted her to have 5MG (which is 0.25mL) Q4hrs. The order was entered into the computer as Roxanol 0.5MG/0.25mL, and she had been getting 0.25mL Q4hrs. by staff. During the 11-7 shift (we have to do chart checks on all new orders), the error was discovered. The resident has been getting 0.5mL Q4hrs for the last 3 days.

Now, my co-worker (another LPN) found the error, and I double checked the order along with our supervisor. We feel that the order was improperly written by hospice. My calculation confirms that:

D/H x Q = dose. 5MG

20MG X 1mL = 0.25mL. (what I feel they intended to write it for.)

The more we try to figure it out, the more we are getting unsure of ourselves. What are some other thoughts on this??

[tencat]

Yes, the order was written wrong. It should have been 5mg/0.25mL. Hospice nurse was probably thinking of the standard we often use: 0.25mL to 0.5mL q 4 hours. We use a range where I work depending on the severity of the symptoms. 0.5 mL isn't out of line as a dosage, meaning it probably won't send the patient into the Great Beyond. But it is an error as it was written.

[mc3, ASN, RN]

Yup, sounds like the order was written wrong. And I agree, in a hospice patient the 0.5 ml wasn't awful, but...

Good job in double checking!!!

hospice mc3:nurse:

[hottiemom04, BSN, RN]

Did nobody think to call and double check???!!!!! Doesn't the MD have to sign off on the order also if it was written by the hospice nurse????? And how many nurses administered this without asking???? 1 is too many. Who's to say the actual amount the patient even recieved if each nurse had different interpretations. VERY SCARY.

[NurseAlwaysNForever]

Normal order for Roxanol at the Hospice I work for is.

Roxanol 20mg/ml 0.25-1 ml po, sl q1h prn pain/discomfort

(as well as)

Roxanol 20mg/ml 0.25-1 ml nebulized Q1h PRN SOB/dyspnea/resp. discomfort

This order should have been clarified before it was ever administered. Everybody makes mistakes when transcribing orders at times, but as soon as it was noticed it should have been verified. Our nursing facilities are very quick to call us with any questions, no matter what time of day or night. How long ago was this order written?

[pielęgniarka, RN]

My guess would either be: 0.25 ml (5mg) or what the other nurse said: 0.25-0.5 ml (5mg-10mg).

We've had hospice pts getting 1ml (20mg) hourly round the clock so it's not like an alarming dose or anything. To me.

Whenever I'm unsure of a dose, I have another nurse look at it and I ask "how would you read this order?" then follow up with hospice or the MD to clarify as needed.