Titrate med orders

[Jabramac]

Although I don't know the specific JCAHO mandate, the hospital I work at tells us that JCAHO, in there last visit, wanted us to not use titrate orders. I don't know if this was intended for for every department. Our hospital has decided to eliminate all titrate orders hospital wide, including the ER, as of a couple of days ago. Now the physician needs to order the specific amount of meds the pt is to recieve and a new order is needed for further meds. Have other ER's gone this way? I see it creating a lot of work for the nurses in tracking down the physician each time a more pain meds are needed.

[KatieBell]

Interesting. We generally do not get med orders in the ED to repeat pain meds.

We do get parameters to titrate drips to keep pressures in an acceptable range etc...

I can not believe JCAHO would require a physician write a new order to titrate up and down a drip in a critical care area.

[canoehead, BSN, RN]

Talk about a waste of time and effort.

[BittyBabyGrower, MSN, RN]

We were also told we could not have titrates either in our hospital. It usually isn't a problem since we are a teaching facility and there is always some resident floating around, but I can see how this would be a PITA at other places.

[sjt9721, BSN, RN]

Joint frowns upon orders that give too many choices:

Morphine 2-4 mg every 1-2 hours as needed for severe pain

And PRN orders must be specific:

...for moderate pain, or ...for nausea unrelieved by Phenergan

We routinely have orders to titrate/wean medications (typically IV drips) but have specific parameters to follow. They didn't have a problem with it when they visited us a few months ago.

[flashpoint]

We were allowed to titrate meds that is was common standard of care to titrate...dopamine, nitro, insulin drips, etc, but we weren't allowed to have "sliding orders" like Tylenol 500 mg 1-2 tabs q 4 - 6 hours. It had to be written Tylenol 500 mg 2 tabs q 4 hours. Their logic was that making the decision to give 1 tab instead of 2 or two instead of 1 was prescribing (or something like that) and if it could be given at least every 4 hours, then 6 hours was within that limit, so there was no reason to write it.

[SaraO'Hara]

What on earth is a titrate anyway? I'm a pre-nursing student and have wondered since seeing it one day in another thread.

[erjulie]

What on earth is a titrate anyway? I'm a pre-nursing student and have wondered since seeing it one day in another thread.

changing the dose of the drug in response to a change in the patient's condition. For example, escalating chest pain pt's nitro can be titrated (in htis case,increased) until the pain is relieved. or, insulin drips can be increased or decreased in response to the pt's blood sugar. The order should be written with specific parameters, however, in our ED, we titrate some drugs without a written order, but believe me the doc is fully informed.

[susi_q]

What a PIA. We routinely titrate pain meds. Typical orders of 0.5 dilaudid up to 2 mg total as needed for pain... isn't that where our nursing assessment comes into play? we didn't prescribe the drug...the sliding order just allows us to give the amount that is right for that patient. IMHO