Silly to have this clarified?

[Lahryn04]

Hey guys! So I just recently hung a protonix drip on a pt with a GI bleed. The order from the ER doc read like this "protonix IV 8mg/hr" that's all. Pharmacy sent me up 4 vials of protonix with 40mg in each. The instructions they sent with it told me to take a bag of 100ml NS, draw out 20cc of NS and reconstitute each protonix bottle with 10ml (only 2 vials were to be used) and inject them back into the bag. So that left me wondering why they sent 2 more vials... Called pharmacist to clarify and she said I was to push 80mg first then start the drip. This did make sense to me but I had never done one of these so I asked 4 other coworkers who had... The first 3 had never pushed the 80 prior to the drip. The last one had but stated the docs order said to that. Called the pharmacist back who told me it's policy to do that, I asked her to write a clarification for me and she put up this attitude. After telling her I refused to push the bolus until I had a clarification she eventually did write one... But not before making me feel like an absolute idiot.... What are your thoughts on this...

[dissent]

Just to clarify, you meant Protonix 80mg/hr. :)

I would have acted in the same manner. There was no order for 80mg bolus, then 80mg/hr drip...and if 3/4 nurses had never done it before and 1 had an explicit order, how is it a well know policy?

Um, let me just clarify , Protonix is infused at 8mg/hr -- that is standard dosage! It doesnt matter how big or small the pt is, 8mg/hr is is the "staple" or "standard" dose of Protonix for GI bleeds.

Yup. For most drips you need to bolus to get to steady state prior to initiation of a drip (ie SL NTG or 400mcg prior to a nitro drip). For a GI bleed it is a standard initial dose (80 mg IV) and a standard drip dose 8mg per hour. It is the doctor's fault for not putting in an order for the initial order. Good for you and the pharmacist for catching it.

[joycelorelle]

It's never, never wrong to have something clarified. Even if it is explicit -- we don't want to do extra harm. Although, as others have said, I would have checked with the doctor too -- especially after the pharmacist told you to do something that hadn't been ordered that way.