What does this order permit? In terms of frequency?

Updated | Posted
by Della4 Della4 Member Student

Specializes in RN Student.

order-permit-frequency.jpg.ab6cc4211c16a8db5ea0cc4fd45d8bc6.jpg

Tylenol 3 

Take 1 to 2 tablets daily when required for pain. Max daily limit 3000mg from all sources. 

Is this only one per day or when needed (perhaps more than once) or only 1 per day? Or when required as long as the 3000mg limit is not exceeded? 

Thank you. 

supersarah

supersarah

Has 8 years experience. 2 Posts

How may mg per pill? 3000mg max a day. Normally the order would say q6h not jist daily. Ask for clarification

faithjohn

faithjohn

66 Posts

It sounds to me like it's 1 to 2 tablets per dose as needed (PRN).

Edited by faithjohn

Della4

Della4

Specializes in RN Student. 33 Posts

1 hour ago, supersarah said:

How may mg per pill? 3000mg max a day. Normally the order would say q6h not jist daily. Ask for clarification

Yes sorry. It refers to total acetaminophen if there may be regularly scheduled acetaminophen.  The T3 has 300mg acetaminophen,  8mg codeine 15 mg caffeine.  

To me it means 1 tab when needed so more than one a day can be admin as long as max daily dose of acetaminophen is not exceeded. 

If it meant only one a day  would it not say , "take 1 to 2 tab once a day as required...."  ? 

faithjohn

faithjohn

66 Posts

59 minutes ago, Della4 said:

Yes sorry. It refers to total acetaminophen if there may be regularly scheduled acetaminophen.  The T3 has 300mg acetaminophen,  8mg codeine 15 mg caffeine.  

To me it means 1 tab when needed so more than one a day can be admin as long as max daily dose of acetaminophen is not exceeded. 

If it meant only one a day  would it not say , "take 1 to 2 tab once a day as required...."  ? 

 it looks like it's not more than 2 tabs per dose. if it was 1 tab, it would only say 1 tab.

londonflo

londonflo

Specializes in oncology. Has 45 years experience. 2,040 Posts

1 hour ago, Della4 said:

The T3 has 300mg acetaminophen,  8mg codeine 15 mg caffeine.

Tylenol #3 does not have caffeine in the US and the codeine is 30 mg. I believe.

chare

3,507 Posts

5 hours ago, Della4 said:

Tylenol 3 

Take 1 to 2 tablets daily when required for pain. Max daily limit 3000mg from all sources. 

[...]

As the order is written, I interpret it to mean a once daily dose of either 1 or 2 tablets.  As you wrote above.  The max daily limit of 3000 mg refers to total acetaminophen in a 24 hour period. 

3 hours ago, Della4 said:

[...]

If it meant only one a day  would it not say , "take 1 to 2 tab once a day as required...."  ? 

I'm not sure that I would interpret this any differently than what I quoted above from your initial post.

Either way, this is a poorly written order, and it would be wise to contact the provider for clarification.

Della4

Della4

Specializes in RN Student. 33 Posts

2 hours ago, londonflo said:

Tylenol #3 does not have caffeine in the US and the codeine is 30 mg. I believe.

Sorry I wrote that wrong. 300mg acetaminophen,  30 mg codeine, 15mg caffeine.  I'm a Canadian nurse. 

Della4

Della4

Specializes in RN Student. 33 Posts

1 hour ago, chare said:

As the order is written, I interpret it to mean a once daily dose of either 1 or 2 tablets.  As you wrote above.  The max daily limit of 3000 mg refers to total acetaminophen in a 24 hour period. 

I'm not sure that I would interpret this any differently than what I quoted above from your initial post.

Either way, this is a poorly written order, and it would be wise to contact the provider for clarification.

I agree. I play it safe and only admin 1 per day. However this person is in allot of pain. 

It's tricky because my facility also has residents with less care than usual LTC. So it makes our job a bit different. The independent residents are required to make their own appointments or family is to do it.  So we generally do not SBAR for the more independent residents. In which this one is. Otherwise I would just SBAR the Dr. I might anyway because this person is in pain and cannot always make their own appointments and such. I'll get called on it but pain is an exception factor to the rule. 

traumaRUs

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 30 years experience. 164 Articles; 21,155 Posts

After reading all the replies, there is much confusion so the correct answer is to clarify the order with the prescriber

 

JKL33

6,269 Posts

"Daily" is the frequency, can be taken to mean once per day. If it were meant to be more than one incident of medication administration per day it would say so.

In ancient times "daily" would have been written "QD," now that abbreviations cannot be used various systems spell it out in their own preferred format; might say "daily," "once daily," "one time per day," etc. It all means the same thing.

If the prescriber wanted the patient to have the option of medicating on more than one occasion per day, there are other ways that would be written, such as "1 tablet two times daily PRN pain" Or "1 tablet daily if needed for pain, may repeat x 1 if no adequate relief," etc. Maybe the provider does want that, but that's not the way they wrote the order.

Technically this order means that once a day the patient can be given one or can be given two.

Edited by JKL33

Been there,done that, ASN, RN

Has 33 years experience. 6,854 Posts

"Tylenol 3 /Take 1 to 2 tablets daily when required for pain." Patient  is prescribed one or two tabs of Tylenol #3 every day. Provider is covering their assets by stating no more than 3000 mg of Tylenol per day, from any other sources. In terms of frequency , it is  one or two daily.  

Can't go wrong by asking for a clarification. During the clarification... give the prescriber a lesson on how to right a correct medication order.