Uncomfortable with Batrim order transcription.

[AraJZgam]

At the start of my 3-11 shift last Sunday, I found the RN Supervisor had trascribed a telephone antibiotic order to read: "Batrim PO BID X 7 days for UTI." I was informed during the shift change report that the patient who previously had no trouble swallowing whole pills, had difficulty taking the bigger antibiotic tablet. The morning shift nurse had to break the tablet. I at the time assumed the patient was on Batrim DS which is bigger than the SS variety. I observed that the MAR just indicated "Bactrim." I notified the outgoing Supervisor responsible for the transcription, and suggested the order needed to specify either Bactrim SS, or Batrim DS. My concern was that the order was not specific, and was open to interpratation with the possible risk that the patient could get the wrong medication. Typically, orders received during the weekend require we obtain the medications from the emergency box awaiting pharmacy delivery of the rest of the medication package on Monday. Both the outgoing Supervising RN, and the 3-11 Supervisor insisted "Bactrim" meant "Bactrim SS." I tried to point that years ago I worked in a LTC facility who were taken to task by state surveyors for writing a Bactrim order that was not specific blaming the transcription for an apparent medication error. The outgoing Supervising RN retorted, "You work here now. I have done this for 30 years, and I am not about to do it any different." A Hospice Consultant RN who was nearby also agreed with them that the order as written was correct. Basically all three RNs said "if" the doctor wanted Bactrim DS, he would have said so, and that "all nurses" know Batrim is Bactrim SS, and not Bactrim DS. I posit to them that using the same logic would they be comfortable transribing an order as "Tylenol" without specifying the strength. I was surprised when all three RNs told me an order transcribed as "Regular Tylenol" was correct because it meant "Tylenol 650mg." They said they write such orders all the time. Something about this bothers me. Medication orders that are ambigious, non specific, and are open to interpratation inevitably lead to medication errors, or near misses. Given their attitude, I can't even begin to imagine the possible damage these nurses could have done in their 70 + combined years of nursing practice. Who is right in this matter?

[nightengalegoddess]

I think you need to work in a real hospital. We need more of you.

[Double-Helix, BSN, RN]

You are. Any order should have the strength of the medication, as well as the dose. Not only does this order fail to include a strength, it also doesn't include a dose (one tab, two tabs, etc). If you have to give the medication, I'd call the doctor yourself before giving it and be sure to specify in your notes what was said.

[breaktime]

Personally anyone who thinks an ambiguous med order is OK scares me a little. "All nurses" know Bactrim is Bactrim SS? If both medications (SS and DS) are in the formulary, I would want to know which one specifically was ordered. I'm a nurse and wouldn't automatically know it was SS. Granted I'm a relatively new nurse, but I think the simple fact that any nurse might not know is reason enough to clarify the order.

Even if these other nurses have been alright with orders like this and "regular tylenol" in the past, you pointed out that it was possible for the order to be unclear, so the "we've always done it this way" attitude is, in my opinion, inappropriate. Of course, like I said, I'm a new nurse, maybe this is perfectly acceptable, but I'd still be uncomfortable. We frequently request our MDs to rewrite BID, TID, and daily orders as Q12, Q8, and Q24 orders when appropriate for the sake of clarity. Med errors are one of the things that scare me the most, and anything that will make it less likely that I make one, is a good thing in my book. That's my

[sharpeimom]

you are 100% correct. as far as breaking a bactrim in half is concerned, i had a stroke eight years ago and when i'm tired, sick, achy, etc., i sometimes have problems swallowing bigger meds and either bactrim is big. the med i took in the morning with no problem whatsoever, can become impossible to swallow by late afternoon or evening. with me, a pill presents more of a challenge than a capsule does.

any compressed med is harder to get down when i'm tired or sick, and breaking it in half, at those times, works better than putting it in jello or pudding does. being flexible is the key.

[RanieRN, MSN, RN]

You're correct. I'm thinking some of your coworkers might have forgotten the 5 "rights"...

[netglow, ASN, RN]

Well, then what you do is call the MD for clarification. Don't bother with people who don't want to help - that always is the longest way around the block.

[dudette10, MSN, RN]

I found this.

http://antibiotics.emedtv.com/bactrim/bactrim-vs.-bactrim-ds.html

It seems that Bactrim SS is written as "Bactrim" and Bactrim DS is written as "Bactrim DS." I, too would be more comfortable with the order written as "Bactrim 80/400 PO BID x 7 days."

As for the Tylenol, I'm lost on where "regular tylenol" = 625 mg. According to this, the term "regular strength" is actually 325 mg.

http://arthritis.emedtv.com/tylenol/tylenol-dosage.html

[CoffeeRTC, BSN, RN]

I think you need to work in a real hospital. We need more of you.

Yikes...really? We aren't all that bad.

I'm glad people like me and the OP do work in LTCs and do care.

Why couldn't you just call and get it clarified yourself? I understand that they might just want one nurse making calls to the doc, but if you want something done right........

You are correct tho, but I will be honest..at our place it is normally written as Bactrim or Bactrim DS.

As far as the tylenol example...tylenol needs an excact dose. Ours is generic and comes in 325mg so for the most part all of our orders are tylenol 650mg po prn or if it is extra strength it is writtin as Tylenol 500mg .

[Esme12, ASN, BSN, RN]

:smackingfBatrim is not Bactrim......they are wrong. I would have called for a clarification. They may heve been doing it for years but that doesn't make it right! I find it unconscionable for a profesional to act like this......:grn:. Follow your instinct and do it the "right" way.

:)

[kakamegamama]

I Googled "batrim" just to see if there is a drug by that name & didn't find one. However, if there were, and the nurse who transcribed the order wrote "batrim" but meant "bactrim" I'm worried about the danger of that! And the "we've always done it this way" mentality is scary as well. Another poster said that some of them seem to have forgotten the 5 righs & I'd say "Indeed!". Hang in there & always keep the patient first! Whew!!!

[SuesquatchRN, BSN, RN]

Am I the only one wh thought "Batrim" was a typo by the poster?

Anyway, I wouldn't have worried about this one given that "Bactrim" were written. BID always means plain old Bactrim and QD = DS.