I'm curious to see what the feedback will be to this question. I've had some agree and some disagree.
Scenario: I have a patient who can get 5-10mg oxycodone q4h. Can I give her 5mg of oxycodone every 2h? She doesn't like to take the 10 all at once and her pain was very well controlled with 5mg every 2-3h. The oncoming nurse said we couldn't do that. But it's not overdosing. So long as she only gets 10mg total in a 4 hour period its all the same thing, is it not? I just make sure there's at least 4 hours between every other dose. So if she gets 5mg at 10 am and then works with PT and wants the other 5 at 11am, I now will until at least 2pm to give another 5. The daily max is the same: 24h/4 =6, and 6x10mg= 60mg/day. 24/2=12, and 12/5= 60mg.
I would have no problem with you giving the medication in the manner you describe and it wouldn't violate the policies of the facilities where we admit patients
Specializes in orthopedic/trauma, Informatics, diabetes.
5 mg Q2H is not the same as 10 mg Q4H. I work on an ortho unit and it is very clear in our policy about meds. If a pt has 5-15 mg Q3H, we dose based on their pain score. And they do have to wait 3 hours for next dose unless there is an order for IV break through meds.
I agree with PP about needing a long acting narcotic and then short-acting for breakthrough.
Specializes in Infection Prevention, Public Health.
To the OP, Though we can all have ideas about best practices for pain management, I do not believe that is what you are asking us. You medication order is for every 4 hours frequency. In the context of this order, it would be a med error to give this med every 2 hours.
I've always believed and been taught that you can give a partial dose, then give the rest if the pain control isn't adequate, then wait the allotted interval until the next dose.
Example: Your order states "10mg oxy IR q4 PO PRN pain."
Your patient says that's too much and makes them loopy, even though their pain is 8/10.
You give 5mg oxy IR at 0800. You check in an hour later and your patient is at 6/10 and clinically appropriate to give the second half of the dose at 0900. After that, the med isn't available again until 1300.
I would worry about overdosing if I started the 4 hour countdown with the first dose.
To the OP, Though we can all have ideas about best practices for pain management, I do not believe that is what you are asking us. You medication order is for every 4 hours frequency. In the context of this order, it would be a med error to give this med every 2 hours.
It's definitely not a universally acknowledged med error. The order gives you an upper limit of medication that can be given in a certain time frame, in this case 10mg for every 4 hour timeframe. 5mg every 2 hours does not exceed 10mg over a 4 hour timeframe. (5 q2 = 10 q4).
I'm curious how someone would discuss this with the Dr:
Nurse: Hi Dr. So-and-so, I'm calling because I gave the patient 5mg and they are still in pain that requires treating.
I say that you need to find out what your facility says about this. At mine, which is LTC), we can do what you are saying.
So, my resident is complaining of pain and she has an order of 1 - 2 pills q 6 hours PRN. Depending on the amount of pain, we can give one and then if she is in pain up to that 6 hour period, we can give her the second one. Now, if we give her both pills, we have to wait the 6 hours. We find her pain is controlled better by giving one at 3 hour intervals or there about.
Even if the OP's interpretation of this order isn't considered a med error, I still think that it has a high risk of causing a med error. I wouldn't necessarily call a Doctor in the middle of the night to clarify this but I would bring it up the next time he/she rounds. In my facility, patients with range orders are medicated according to pain scale and then must wait until the next interval to receive medication again. It is always better to clarify the order with the physician so that everyone is practicing the same way. Patients become very angry and difficult to work with when they receive conflicting info from different nurses.
Specializes in Palliative, Onc, Med-Surg, Home Hospice.
The policy at my facility is this: If an MD gives a range and we start with the lowest amount (say 5mg), we have1 hour after that dose is given o give the maximum. If, 2 hours after the patient take the first dose, they complain of breakthrough, we either have to use another med on the profile or call the MD. Some pt we just know that they need the max, so we give it.
Specializes in Palliative, Onc, Med-Surg, Home Hospice.
If your patient is taking 60mg of oxycodone/day, s/he needs to be on a long-acting opioid like OxyContin, with a short-acting med like OxyIR for breakthrough. It makes no sense to b medicating someone q2h, for a multitude of reasons.
I work Onc/Palliative. I have pt who have sickle cell, glio's (two with stage 4 at this moment), lung, liver, and pancreatic CA's with and without mets. I have pt who are actively dying. I have seen ranges of Q15min (20mg Roxanol) to Q8 for 10mg Norco (or Percocet). And everything in between. My sickle cellers (well know to us, well loved and nearing the end of their lives) will have 2mg Dilauded q2H at admission and eventually work down to 2mg Q4h.
Sometimes a pt needs the pain meds very frequently (my dying pt who has Lung CA with liver, bone and brain mets, or my sickle cellers) and I have pts begin weaned off the IV morphine getting it Q8H. It depends on the situation. A blanket statement of "It makes no sense to..." doesn't make sense to me.
We have range orders on all most all prn Pain meds and even Phenergan.
We also have multiple different types of pain meds.
We interpret the range order the same way the OP does. Sometimes we do have to give multiple meds to get them down especially if their pain has been neglected for a while. Sometimes if we get an order, we can give PO Pain meds with a PCA.
scottaprn
292 Posts
I would have no problem with you giving the medication in the manner you describe and it wouldn't violate the policies of the facilities where we admit patients