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.
Actually she said it was the most controlled her pain has been. 5mg did work, she just needed it about every 2-3 hours. And she no longer needed IV morphine. And with Tylenol ATC, each day she needed less and less narcotic. Like I said, 10mg all at once made her too loopy, which she said was fine at night when she planned on sleeping anyway. My goal is reduce peaks and valleys in pain scores.
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.
What do you think??
OP- no matter what the Nurse Gods tell you.....you can not give a dose every two hours. Using your logic, you could give 2.5 mg every hour, or 1.25 mg every 30 minutes, or just shave a little off every 5 minutes and give it to the patient.
BTW-Position statements do not carry the weight of law.
Actually she said it was the most controlled her pain has been. 5mg did work, she just needed it about every 2-3 hours. And she no longer needed IV morphine. And with Tylenol ATC, each day she needed less and less narcotic. Like I said, 10mg all at once made her too loopy, which she said was fine at night when she planned on sleeping anyway. My goal is reduce peaks and valleys in pain scores.
I would delete this post. It is now prima facie evidence (sort of). Unless, of course, you did the reasonably prudent thing and called the doctor to adjust the prescribed dose interval.
Here's where I get stuck. I hope this makes more sense than my last post.
"Sue" gets 5mg at 1500
She wants another 5mg at 1700
At 1900, when I come on, she want the whole 10mg because her pain is 10/10.
Her last removed pain med dose has only been 2 hrs. The parameter is 4 hrs. She's been getting pain med very 2 hours and she doesn't understand why I won't give it too.
If I give the full dose of 10 mg at 1900, aren't I making a med error? Or am I over thinking this whole thing?
Sue cannot have any more of this pain med until 2100. I believe the clock resets with the last of her dose. A provider will need to be notified for new orders. It looks as though her pain is not being managed adequately anyway and she will need something added for breakthrough.
I would also be very careful with giving Tylenol (I thought I saw someone suggest that in a pp). Percocet and lortab have Tylenol and if she has been getting it every 2 hours then it can be a problem.
Specializes in Oncology; medical specialty website.
So just to hit the highlights so we aren't to vague. ASSESS THE PATIENT BEFORE YOU MAKE BLANKET STATEMENTS ABOUT HOW THEY SHOULD BE CARED FOR. Also, don't claim that someone doesn't understand a topic on which they can run circles around you.
That is not what you said in your OP. You said the nurse should "know things about the patient and the situation..." Know what things? That the patient prefers New York style pizza to Chicago deep dish? It's a vague statement. Had you said that the nurse should assess the patient's pain, get to know a little about the patient's pain history, etc., I would have agreed with you.
If you truly believed that the poster you're talking about was in error (or any other nurse you deal with, for that matter) instead of coming across in a bombastic manner, why not try to educate where you see knowledge deficits? There is no place in this profession for demeaning one another. You would be in a perfect position as an advanced practice nurse to lead others.
I think the reason the nursing profession doesn't advance is due to nurses belittling each other. It's like kindergarten. There's no place in a profession for childish behavior. Some nurses feel the need to demean other nurses. Based on your comments here, I have to wonder how you treat nurses you come in contact with on a day to day basis.
Like I said, I find it interesting that when I worked in hospice, it was very common for attending to consult with me and my hospice colleagues about pain management. I think there's a message here that physicians are willing to learn from nurses, but an APRN rejects the idea that he could learn anything from a "lowly" RN.
I hope your little episode of chest thumping made you feel better.
FWIW, when I was starting out working in pain management, I was mentored personally by one of the best there is in pain management: Margo McCaffrey. An excellent teacher, and someone who was as down-to-earth as they get.
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.
Disagree - it depends on the facility. Your blanket statement is untrue.
Specializes in Infection Prevention, Public Health.
That is true, but that doesn't mean anyone committed a "med error."
That may be true. It depends on your unit policies. For some facilities it would indeed be a med error and at others it may not. In either case, a less ambiguous order would be an improvement.
That may be true. It depends on your unit policies. For some facilities it would indeed be a med error and at others it may not. In either case, a less ambiguous order would be an improvement.
If there is a unit policy anywhere in the USA or its territories that allow a Nurse to so liberally "interpret" a doctor's order for a schedule II substance, then I would love to see them
If there is a unit policy anywhere in the USA or its territories that allow a Nurse to so liberally "interpret" a doctor's order for a schedule II substance, then I would love to see them
I wouldn't do that every 2 hours. When you give her the second dose, you would time it 4 hours from it. Now our hospital has ranges like that (surgical patient care floor- so I give out pain meds literally every 2 to 4 hours for most patients), but they also enacted that we have to do a pain reassessment every hour. So, let's say you gave her 5mg at 10a and then you re-evaluate her at 11a and she says she wants the other 5mg. We are allowed to do that since the order says 5-10mg but it has to be between that one hour period.
Sitch321
61 Posts
Actually she said it was the most controlled her pain has been. 5mg did work, she just needed it about every 2-3 hours. And she no longer needed IV morphine. And with Tylenol ATC, each day she needed less and less narcotic. Like I said, 10mg all at once made her too loopy, which she said was fine at night when she planned on sleeping anyway. My goal is reduce peaks and valleys in pain scores.