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?
Am I the only one wh thought "Batrim" was a typo by the poster?
I did too.
However, this does bring up the need to transcribe accurately. How many drugs require the tall man letters to differentiate them? Too many, in my opinion.
I really see no problem. Bactrim is just that -- Bactrim. BactrimDS is -- Bactrim DS. And Tylenol is Tylenol (please don't start down the T3 path, it's just not relevant here), with whatever dosage is specified.
There is a certain irony in the original post, taking nurses to task regarding specificity, but also containing repeated typos in the name of drug, to the extent that it caused some other posters to question whether there was a separate drug named "Batrim".
Specializes in Gerontology, Med surg, Home Health.
During the last DPH survey, the facility I now work at got cited because med orders weren't complete. The order read "Coumadin 5mg daily." We all know that Coumadin is always given by mouth, but the doc left it out of the order. Picky perhaps but every order needs to be complete. We don't have 650mg of Tylenol. We have 325 mg tabs. If we wrote Tylenol 650 mg by mouth every four hours as needed for pain, we would get cited.
Bactrim is the same idea...the DS needs to be spelled out. And sometimes, the DS is given more than once a day.
During the last DPH survey, the facility I now work at got cited because med orders weren't complete. The order read "Coumadin 5mg daily." We all know that Coumadin is always given by mouth, but the doc left it out of the order. Picky perhaps but every order needs to be complete. We don't have 650mg of Tylenol. We have 325 mg tabs. If we wrote Tylenol 650 mg by mouth every four hours as needed for pain, we would get cited.
Bactrim is the same idea...the DS needs to be spelled out. And sometimes, the DS is given more than once a day.
I know I am being nitpicky here, but coumadin can be given IV, I give it IV frequently. This is a very good example of why orders need to be complete and not open to interpretation, sometimes nurses don't know all the routes of "common meds".
I've had this problem working in psych. The consultants (specialists) don't write the med properly, but when I complained, the other RNs/EENs said that you can't tell them & refuse to give meds cos it's a private hospital.
You are right. And BTW, I have not given a medication cos it wasn't written properly, & no doctor etc was there to check with etc (it was a rehab place, part of the hospital but once patient is d/c we use locums), so I didn't give the medication. Then about 2 days later I got told off for not giving it - the patient complained apparently. Anyway I argued & said u must get the docs to write these properly b4 patient leaves the hospital. I think it all fell on deaf ears, but haven't heard anything else.
Stick to ur guns - it's hard, but in some private places you can't argue unfortunately, but do not ever jeapordise ur license.
i know i am being nitpicky here, but coumadin can be given iv, i give it iv frequently. this is a very good example of why orders need to be complete and not open to interpretation, sometimes nurses don't know all the routes of "common meds".
i also give coumadin via gtube so it is not just by mouth.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I know I am being nitpicky here, but coumadin can be given IV, I give it IV frequently. This is a very good example of why orders need to be complete and not open to interpretation, sometimes nurses don't know all the routes of "common meds".
I have to tell you that in 33 years of being an RN I have NEVER given IV coumadin nor have I EVER seen it used! I had to look it up and I was stunned....gotta LOVE AN! :redbeathe
Intravenous warfarin, approved for use by the United States Food and Drug Administration, provides an alternative administration route for patients who cannot receive the oral formulation and cannot use subcutaneous low-molecular-weight heparins due to adverse effects. Adverse effects of intravenous warfarin are similar to those of the oral form and include hemorrhage, hematuria, melena, and necrosis or gangrene of the skin.The efficacy and toxicity of intravenous warfarin are monitored by INR, prothrombin time, and hemoglobin levels.
Intravenous warfarin dosages are the same as those required for oral anticoagulation. After reconstitution of the 5.4-mg vial with 2.7 ml of sterile water for injection, the 2-mg/ml solution is stable for 4 hours at room temperature. As a result, each vial is single use only. Warfarin for injection is incompatible with many drugs, including heparin, and therefore drug compatibilities should be reviewed before it is administered through a patient's intravenous line. Warfarin for injection should be administered as a slow bolus over 1-2 minutes into a peripheral vein. It is not to be given intramuscularly and is not approved for direct intravenous push.However, clinical experience, including the experience with our patient, suggests that it can be administered as a direct intravenous push injection without complications.
Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.
I would definitly be clarifying that Bactrim order. I, personally, have only seen and used Bactrim DS (and it can be given BID) in my 14 years of nursing - especially if this is for a UTI. I am definitely not saying that regular strength Bactrim isn't used - but yes, I would DEFINITELY be clarifying that order with the dosage strength!
Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.
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.
No it does not! Bactrim DS is typically given BID for UTI's.
It might be that in LTC facilities the older folks might have decreased renal function so that plain Bactrim might be given vs. the Bactrim DS - but I would still be double-checking that order, especially if the patient's CrCl is fine.
Specializes in Gerontology, Med surg, Home Health.
I know I am being nitpicky here, but coumadin can be given IV, I give it IV frequently. This is a very good example of why orders need to be complete and not open to interpretation, sometimes nurses don't know all the routes of "common meds".
This is long term care...not once in almost 30 years of nursing (including the hospital) have I ever seen Coumadin given IV....heparin sure, but never Coumadin.
AraJZgam
2 Posts
Correct, "Batrim" was my error, the poster. I meant Bactrim. I am so encouraged by the responses here.