Written Up

[medteleER]

The oncoming shift charge nurse got on me about "double dosing" a patient. MD had (2) specific orders PRN:

1) xanax 0.5 mg for sleep

2) xanax 0.5 mg q8h for anxiety

I gave BOTH of them because the patient claimed being anxious and wanted something to sleep. My charge nurse pulled me to the side afterward and stated she was going to write it up. The patient was VSS in the morning. I'm not sure how I should be feeling about this.

[Daisy4RN]

2 hours ago, Emergent said:

Was my humor too subtle for your average IQ ?

Well, being the intellectual that I am I of course realized that your post was meant for humor purposes. I would also share my IQ except I am afraid it might make you feel inferior.

[Emergent, RN]

Just now, Daisy4RN said:

Well, being the intellectual that I am I of course realized that your post was meant for humor purposes. I would also share my IQ except I am afraid it might make you feel inferior.

Can you play the guitar? ?

[Guest219794]

I think the dose may not have been a big deal, but the rationale was less than sound.

Using that rationale, you could have also given some ativan for vertigo and some valium for a muscle spasm along with both doses of xanax if they were ordered PRN.

Then after they stopped breathing, you could have given some romazicon, but given the likely benzo dependence,they would seize with no effective med available.

[Daisy4RN]

13 minutes ago, Emergent said:

Can you play the guitar? ?

No, but I have played the piano in the past.

[Guest219794]

32 minutes ago, Daisy4RN said:

Well, being the intellectual that I am I of course realized that your post was meant for humor purposes. I would also share my IQ except I am afraid it might make you feel inferior.

You must be very smart if you have IQ to share. I barely have enough for myself.

[Emergent, RN]

33 minutes ago, hherrn said:

Hey, Emergent is the smartest of all

Just discovered I can edit people's quotes

[Emergent, RN]

22 minutes ago, Daisy4RN said:

No, but I have played the piano in the past.

Well, I've played piano in the past as well, albeit self taught, by ear.

[saongiri]

Is it possible that the orders were written by 2 different doctors? That happens sometimes and that is one of things we as nurses need to look out for.

[Wuzzie]

1 hour ago, hherrn said:

I think the dose may not have been a big deal, but the rationale was less than sound.

Yep, that's what I thought too.

[medteleER]

5 hours ago, hherrn said:

I think the dose may not have been a big deal, but the rationale was less than sound.

Using that rationale, you could have also given some ativan for vertigo and some valium for a muscle spasm along with both doses of xanax if they were ordered PRN.

Then after they stopped breathing, you could have given some romazicon, but given the likely benzo dependence,they would seize with no effective med available.

and i'd add some dilaudid for pain and benadryl for the itch. lol. believe it or not we have patients here that receive all of that. maybe it's just where i'm working.

anyway. thanks everybody for the posts.

[murseman24, MSN, CRNA]

11 hours ago, KatieMI said:

"If the provider still wants Xanax, I would call to whoever manages the amiodarone and cardizem and ask that person directly if they think it would be okay. Cardiologists are usually better verced in complicated pharmacology of their own drugs."

As a word advice to the OP, DO NOT DO THIS. Do not call the cardiologist about an order for Xanax from another provider. That should not concern him and you will look like an idiot when he tells you so.

11 hours ago, KatieMI said:

Quote

"I have strong pharmacology background, so doctors usually listened to what I said."

I think they may have just gave you what you wanted so they didn't have to hear you talk anymore.

[lokipr]

Yikes. I hate it when the Docs write confusing orders or write a mix of PRNs of the same med for different reasons. Yes you should never give both the PRN together with the scheduled med. Wait at least an hr. 0.5mg of Xanax is a tini little dose. In all honestly that wont even touch most patients. Also I think the charge nurse here is making things too hard for you. We all make mistakes. This was not a lethal dose or a dangerous dose at all. Writting you up is being to harsh and even catty. She could have just counseled you. Are you a new nurse? I have had newbies make silly mistakes like these and I never try to ruin their careers by writting them up. I teach them. That is what we as nurses are supposed to do. I dont think these are grounds for terminatiin so just accept the write up and explain the missunderstanding and never do that again.