Was I wrong or was the order wrong?

jimthorp · Jan 17, 2006

Please help me! My palliative patient was written up for a continuous subcut infusion of morph 30mg/midaz 20mg/maxalon 40mg. The order stated that this was to be infused over 12 hours.
As this was for a palliative patient and therefore a continuous order, I doubled the amounts and infused over 24 hours. Thus, the patient received the correct amount over the correct timeframe. However, a colleague suggested to me that I should have had the order changed to twice the original amount with orders to infuse over 24 hours.
To me this seems really podantic as I believe I have followed the order to the letter by delivering the correct amount over the correct timeframe, and I had rightly taken into account that the order was continuous.
Please tell me what you think!!

I've never heard of a SubQ infusion. Then agian, I new to nursing.

If you write the order here exactly as it was written maybe someone could better help you.

Gompers, BSN, RN · Jan 17, 2006

What was the frequency of the order? Was it a PRN or scheduled to begin at a certain time? If it was an open-ended PRN, I think it would be fine to keep it going for 24 hours - you were giving the correct dosage, just made it easier for yourself by preparing it all at once. But if it was a one-time order, then it should have either been ordered for Q12H ATC or PRN, with no limit on the amount of times you could give it. Am I making sense?

I don't know how your orders are written - ours are all on the computer and very specific.

froghair · Jan 17, 2006

i would of got the order changed. the reason being i gather the patient was on a syringe driver and they can run through earlier than you think they can also run slow so the patient wont be getting the right dose. it is podantic but legally if something went wrong its your orifice so to speak

hellerd2003, RN · Jan 17, 2006

The order may have been wrong, but the other issue is that I think it's outside of a nurse's scope of practice to change a medication order without consulting with a physician. So, although you may have administered the right medication dosage, a doctor should have been consulted to get the order changed.

elkpark · Jan 17, 2006

Was the original order to run that combination/amount of medication continuously over 12 hours, or to run that amount continuously every 12 hours?? Big difference ...

In either case, you are on v. thin ice legally (maybe no ice at all :) ) changing a physician's medication order without getting a new order ... Even if the doc made a minor boo-boo or wasn't clear in writing the order and you are sure you know "what s/he meant," you cannot just change the order yourself or administer what you think the doc intended. Legally, that is Rxing and outside the scope of your practice.

Bipley · Jan 17, 2006

What brought this to light? Did someone question the order or how you handled it?

grandee3 · Jan 17, 2006

ditto

get the order clarified or changed by the doc who wrote it.

deblew · Jan 17, 2006

some meds are only stable for a certain length of time when mixed together. if a mistake were to happen and the pt recieved the medication too quickly the outcome could be tragic.