Published Apr 27, 2014
I've been an LPN for just shy of 5 years and had a strange order come in. For confidentiality and covering my behind, I'll use fake medication names. One is an OTC and one is a narcotic.
Order is as follows:
OTC x 2 tabs p.o. every 6 hours until Monday, April 28th, 2014.
If above order does not alleviate pain, replace one OTC tab with one Narcotic tab up to twice per day. Do not give if client is drowsy or dopy and ensure that you space the Narcotic administration times far apart. On April 29th, 2014, give OTC x 2 tabs TID, regularely and use Narcotic with same rules as above.
Essentially, use nursing judgement and don't be an idiot with narcotics. I digress.
When writing this order into the MAR, is it pertinent to have those "rules" written as well? My way of thought is that we can cut down the wording so that we maintain the 10 rights without needing the wordiness of the common sense/nursing judgement.
That's an absurdly complicated medication order. I would refuse to note it as is, and demand the doctor clarify and simplify it.
It would make more sense to just order the OTC scheduled TID along with the narcotic PRN for breakthrough pain.
That's an absurdly complicated medication order. I would refuse to note it as is, and demand the doctor clarify and simplify it.It would make more sense to just order the OTC scheduled TID along with the narcotic PRN for breakthrough pain.
Very good answer. Unfortunately, it was my collegue who wrote down the orders which he obtained via telephone. He then transcribed them. Fortunately, I have not had to use said orders so have not had to clarify the orders.
At places I have worked the pharmacy would kick that back to the doc and make him clarify and simplify.
Altra, BSN, RN
I agree it's not worded well, but its intent is pretty apparent to me.
And while I'm not looking for the OP to disclose further details about this patient or med regimen ... it appears clear to me that this is for some kind of chronic pain, which has probably been worked up pretty thoroughly with negative results.
If treatment for this condition has thus far been on a prn basis ... the patient's provider now wants to try a continuous regimen to control symptoms, before resorting to narcotics. The doc wants to try 1 week of OTC pain reliever (or other OTC med such as Pepcid or Prilosec, in an attempt to control abd pain) b.i.d. If, and only if, that does not resolve symptoms after one week ... we'll try some narcotic pain control, with one day of overlapping meds to transition between the two.
I think this provider was trying to communicate the treatment plan to the nurses through this order. It would probably have been better to put all that in a progress note, and just order the 7 days of OTC med b.i.d. The progress note could contain instructions to call for further orders if that regimen was unsuccessful.
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