What does this order permit? In terms of frequency?

InHisImage, BSN · Jul 30, 2022

1 hour ago, JKL33 said:

"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.

Yes, I agree.

allnurses Guide · Jul 30, 2022

Tylenol #3 typically contains 300mg Tylenol and 30mg codiene

Maximum daily dose for tylenol is 3000 mg

Maximum dose of codiene is 15 to 60 mg every 4 hours with a daily total not to exheed 360mg

So if you were to give 2 tylenol #3 every 4 hours you would be given a max daily tylenol dose 1200 mg tylenol 120mg codiene max per day.

Much of this is going to depend on the individuals pain tolerance and response to medication. I certainly would not give it more than every four house and call the physician for break through pain.

Microsoft. (n.d.). Bing. Retrieved July 30, 2022, from https://www.bing.com/search?q=maximum%2Bdaily%2Bdose%2Bof%2Bcodiene&cvid=03d097de7bf04204b7aff09fdf3ad8a6&aqs=edge..69i57j0.21346j0j4&FORM=ANAB01&PC=W018

Della4 · Jul 30, 2022

27 minutes ago, hppygr8ful said:

Tylenol #3 typically contains 300mg Tylenol and 30mg codiene

Maximum daily dose for tylenol is 3000 mg

Maximum dose of codiene is 15 to 60 mg every 4 hours with a daily total not to exheed 360mg

So if you were to give 2 tylenol #3 every 4 hours you would be given a max daily tylenol dose 1200 mg tylenol 120mg codiene max per day.

Much of this is going to depend on the individuals pain tolerance and response to medication. I certainly would not give it more than every four house and call the physician for break through pain.

Microsoft. (n.d.). Bing. Retrieved July 30, 2022, from https://www.bing.com/search?q=maximum%2Bdaily%2Bdose%2Bof%2Bcodiene&cvid=03d097de7bf04204b7aff09fdf3ad8a6&aqs=edge..69i57j0.21346j0j4&FORM=ANAB01&PC=W018

Right. I only question it because I would like to administer more than just 1 per day as her pain is not managed effectively. I mean what is 1 t3 a day going to do? I have the same issue with a Ativan order. However these 2 residents are classified as independent in my facility so they are to manage Dr prescriptions themselfs or family. So technically I'm not supposed to SBAR.(ridiculous I know, a whole other thread).

Waiting for a Dr this way doesn't help me on my shift and the person is in pain at that moment.. it upsets me because I have the medication to relieve her pain but cannot administer it.

I'm going to risk having to explain myself and SBAR the Dr anyway. Her pain is more important than following a rule that doesn't make sense.

allnurses Guide · Jul 31, 2022

3 hours ago, Della4 said:

Right. I only question it because I would like to administer more than just 1 per day as her pain is not managed effectively. I mean what is 1 t3 a day going to do? I have the same issue with a Ativan order. However these 2 residents are classified as independent in my facility so they are to manage Dr prescriptions themselfs or family. So technically I'm not supposed to SBAR.(ridiculous I know, a whole other thread).

Waiting for a Dr this way doesn't help me on my shift and the person is in pain at that moment.. it upsets me because I have the medication to relieve her pain but cannot administer it.

I'm going to risk having to explain myself and SBAR the Dr anyway. Her pain is more important than following a rule that doesn't make sense.

In the scenario I posted you could give the Tylenol 3 every 4 hours around the clock and still have break through pain orders. You do have to do a strong assessment to prevent over sedation and respiratory depression. The order lacks the necessary specificity though I would still double check with the physician for clarity

allnurses Guide · Jul 31, 2022

Well if the patient is managing their own meds where would you get the idea they only get 1 dose daily

chare · Jul 31, 2022

44 minutes ago, hppygr8ful said:

Well if the patient is managing their own meds where would you get the idea they only get 1 dose daily

This. And, if they are classified as independent and expected to manage their prescriptions on their own, why aren't they independent enough to manage their own medications as well?

JKL33 · Jul 31, 2022

I don't know if it is your facility that is putting limitations on you (about contacting the prescriber), but if you are the one expected to dole out the medication then it is nonsense to say that you wouldn't be able to contact the prescriber if you have a concern.

Either the patient manages their medications or they don't. I would decline to act as a mere dispenser, your license could be understood to inherently hold you to more of an obligation than that. So if your facility is the one putting these limitations on you tell them to kick rocks.

Della4 · Aug 1, 2022

The medications are "passed" not administered by CNA mostly. It's for residents who are independent but need help managing their medications. They usually have a history of taking too much or missing doses. They are also assisted with meals and some ADL but do not meet full care requirements. It's an in between stage.

The idea is, the resident and families take care of Dr appointment etc and stay as independent as possible. Their health is stable(or is supposed to be) and ongoing assessments are not administered. Almost like home care.

Trasation: it's a small part pre long term care that family doesn't want to pay extra for care not needed yet. It's the idea to keep seniors as independent as possible and those who can manage this should, to preserve resources.

We do not have the resources to administer medications, do assessments and converse with Dr.'s like we would in LTC and especially because the majority of the residents are LTC.

Della4 · Aug 1, 2022

10 hours ago, JKL33 said:

I don't know if it is your facility that is putting limitations on you (about contacting the prescriber), but if you are the one expected to dole out the medication then it is nonsense to say that you wouldn't be able to contact the prescriber if you have a concern.

Either the patient manages their medications or they don't. I would decline to act as a mere dispenser, your license could be understood to inherently hold you to more of an obligation than that. So if your facility is the one putting these limitations on you tell them to kick rocks.

I can contact Dr for the residents that are LTC but this resident class is considered independent only requiring some care.

Della4 · Aug 1, 2022

On 7/30/2022 at 5:14 PM, hppygr8ful said:

Well if the patient is managing their own meds where would you get the idea they only get 1 dose daily

They are locked up in a cupboard(medications). They or family are to speak with Dr about prescriptions etc.

On 7/30/2022 at 5:11 PM, hppygr8ful said:

In the scenario I posted you could give the Tylenol 3 every 4 hours around the clock and still have break through pain orders. You do have to do a strong assessment to prevent over sedation and respiratory depression. The order lacks the necessary specificity though I would still double check with the physician for clarity

Yes I will. And risk getting talked. This person is in pain, I'm willing to do it.

allnurses Guide · Aug 1, 2022

1 minute ago, Della4 said:

They are locked up in a cupboard(medications). They or family are to speak with Dr about prescriptions etc.

I get it but the way the order was written it clearly allows for more than 1 dose per day

Della4 · Aug 1, 2022

2 minutes ago, hppygr8ful said:

I get it but the way the order was written it clearly allows for more than 1 dose per day

That's what I thought too! Thank you. I will get a clarification first just in case. My colleagues are split on what it means, most will not do more than one.