med questions

[spokath]

An issue came up the other day and I disagree with the DNS. Would be interested in some opinions:

Resident was getting a 1/2 of a 5 mg hydrocodone ATC. She also had a 5 mg tab ordered prn which she wasn't ever getting since the 1/2 tab did the trick. It was a Sunday afternoon and I ended up giving the last dose in the card at 12:00. I called the pharmacy for a new card for eve shift and they requested the order. When I looked it up in the chart, the order had been written "hydrocodone 5/325 1/2 tab q 6 hrs, #60. So essentially, she had used the 60 tabs and had no refill order. The doc likes us to communicate with him in writing if not an emergency, so I did, asking if he wanted to continue the ATC order. Then, I dc'c the existing order in the MAR, anticipating that if I did not, the nurses following me would pull out one of the 5mg tabs and break it in half, which, technically,would not be how the prn was ordered. I passed on to the next shift to use the prn hydrocodone until we got clarification from the MD.

In my mind, once the 60 tabs had been used and there is no refills, then it is dc'd until a new order is given. Apparently my DNS did not see it this way and I was told that I was not to dc an order unless specifically written by the doc. I consider the use of all 60 tabs with no refill to be an implied "dc", much the way an abx order for a specific number of days to have an implied "dc" as soon as that number of days expires. Would appreciate any thoughts.

[CapeCodMermaid, RN]

We would just call the doc and ask him to fax a new script.

What is ATC? I've been a nurse for more than 30 years and have never seen that abbreviation.

[JustBeachyNurse, LPN]

We would just call the doc and ask him to fax a new script. What is ATC? I've been a nurse for more than 30 years and have never seen that abbreviation.

I think it's a non-standard abbreviation for around the clock. It was used in a non-healthcare setting

[Sam J.]

Around the clock. I've seen it used only to mean to give the med (Q6HRS, or whatever) as ordered, and not to hold a dose, most often written by hospice to be sure the patient remains comfortable without whatever nurse deciding to hold this dose or that dose based on whatever reason a nurse may not feel the patient needed medicated.

OP said she did talk to the doctor about the empty script, to ask if he wanted to continue it, than apparently did not get a refill order, and told the next shift to clarify the order- this is a confusing situation. It would have saved a lot of trouble to have gotten a new order right off the bat- the discussion with the DNS would not have happened, the next shift wouldn't have to call him again to clarify the order, not to mention the medication would already have been delivered?

[CoffeeRTC, BSN, RN]

This happens a lot to me on the weekends.

The order was still valid so it shouldn't have been DC'd unless it said "dc after 60 tablets or xyz days." What you needed to do was get a new prescription for the ATC meds. I wouldn't have used the prn dose since it was only written for prn and it was a whole tab. In this case, I would have got the doc to call in or fax a script to the pharmacy and also write for use of the ebox for the 1/2 tab if the med wouldn't have been in before the next dose was due.

[NurseQT]

The order shouldn't have been d/c'd, unless specifically written to do so. The #60 was meant for the pharmacy. The DEA regulates how often a hard copy Rx is to be signed by the MD. After 60 tabs have been dispensed than the MD needs to sign a new Rx for the pharmacy, they cannot fill the order until they have that hard copy or have spoken directly to the ordering MD. We've never d/c'd an order when there are no refills left, we just have the MD sign a new hard copy Rx and send it over to the pharmacy.