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?
Specializes in Oncology; medical specialty website.
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".
I take offense at the comment "Who knows how much damage they could have done in their 70+ years of nursing?" As if, "Thank God for me. These experienced nurses know nothing. It's a good thing a younger nurse like me was around to keep them straight."
I take offense at the comment "Who knows how much damage they could have done in their 70+ years of nursing?" As if, "Thank God for me. These experienced nurses know nothing. It's a good thing a younger nurse like me was around to keep them straight."
The OP had this line in it:
"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."
I think the OP has been a nurse for quite some time. She is, however, new to her facility.
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.
Ahh...but I am sure it can be given by G-tube in long term care, which is yet another alternate route. If ordered po, or no route ordered and the agency nurse comes in to fill in behind you, who has never had the pt before, and he can somewhat swallow, then choked on the pill...you just set her up for failure.
Also, I have had pts who have has feeding tubes who could swallow pills, the tubes were just for to improve nutritional status prior to surgery, or for wound healing.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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.
Neither had I but when I looked it up...you can! It's given in special malbsorbtion syndromes and inflammatory bowel disorders when heparin has been ineffective. I was completely blown away!
ahh...but i am sure it can be given by g-tube in long term care, which is yet another alternate route. if ordered po, or no route ordered and the agency nurse comes in to fill in behind you, who has never had the pt before, and he can somewhat swallow, then choked on the pill...you just set her up for failure.
also, i have had pts who have has feeding tubes who could swallow pills, the tubes were just for to improve nutritional status prior to surgery, or for wound healing.
clarity is our friend.
this is what's great with allnurses. you can learn something new everyday. just because you have been a nurse a long time does not mean you know everything - (just a general comment ).
for example, i was working my prn gig (ltc vent) a couple of days ago and was a little shocked to find an order for heparin 5000 units sub-q q 8 hours (ordered last month) and lovenox 80 mg sub-q q 12 hours (ordered 5 days ago) for dvt. i called pharmacist first for advise then i called the md to double check the order. i've been working as a nurse for almost 4 years and never seen heparin and lovenox ordered together. so i learned something new that day.
also, these vented patients at my prn gig all have gtubes for nutrition and 2 of them take their meds po.
Specializes in Gerontology, Med surg, Home Health.
I stand corrected. BUT the resident had NO tube so PO was the only option. We've had a hard time getting this particular doc to write the orders the right way.
). 
OCNRN63, RN
5,979 Posts
I take offense at the comment "Who knows how much damage they could have done in their 70+ years of nursing?" As if, "Thank God for me. These experienced nurses know nothing. It's a good thing a younger nurse like me was around to keep them straight."