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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.

53 minutes ago, lokipr said:

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.

Yes, I agree. This should be more of a teaching moment and also the MD should be counseled on writing orders. More details needs to be added to the order.

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Specializes in Critical care.
1 hour ago, lokipr said:

Yikes. I hate it when the Docs write confusing orders or write a mix of PRNs of the same med for different reasons.

Don’t worry, The Joint Commission is now cracking down on this. Any duplicate therapy PRN medications must clearly state what to give and when. This applies for anxiety, pain, bowel regimen meds, etc. and without very clear cut directions, per TJC, it is out of the scope of our practice to decide what to give the patient.

So the order will need to say give Med A first and 2 hours later if no relief give Med B. Or something similar to that depending on the meds and indication.

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So how did the patient feel after you gave both pills? Did the patient sleep? Were there any adverse reactions that the patient experienced as a result of getting both pills?

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12 hours ago, Workitinurfava said:

So how did the patient feel after you gave both pills? Did the patient sleep? Were there any adverse reactions that the patient experienced as a result of getting both pills?

I highly doubt there was an adverse reaction. Its just 1mg of Xanax.

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17 hours ago, Workitinurfava said:

So how did the patient feel after you gave both pills? Did the patient sleep? Were there any adverse reactions that the patient experienced as a result of getting both pills?

i'm not sure if there were adverse effects, but according to allnurses.com there might have been or was. believe it or not, the patient dropped off a daisy award nomination for me.

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Does your facility have a policy about this kind of orders? If not I would have called the MD like many posters suggested or at least wait 1 hr apart after clarified it with the charge.

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Specializes in Med/Surge, Psych, LTC, Home Health.
10 hours ago, medteleER said:

i'm not sure if there were adverse effects, but according to allnurses.com there might have been or was. believe it or not, the patient dropped off a daisy award nomination for me.

good for you! ? I'm still waiting for mine. I think everyone on my floor has gotten one but me. Must be my sunny personality.

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On ‎3‎/‎14‎/‎2019 at 1:25 PM, Ruby Vee said:

I hope you've learned something about taking the patient's word for what the MD ordered.

the OP may have done precisely what the doc wanted. the order was shottily written

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13 hours ago, medteleER said:

i'm not sure if there were adverse effects, but according to allnurses.com there might have been or was. believe it or not, the patient dropped off a daisy award nomination for me.

That explains a lot. Evil goes where a daisy award goes. They’re practically like pink slips. Accept one and you’ll be fired very soon.

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Specializes in Med/Surge, Psych, LTC, Home Health.
53 minutes ago, Sour Lemon said:

That explains a lot. Evil goes where a daisy award goes. They’re practically like pink slips. Accept one and you’ll be fired very soon.

Huh? Explain.....

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
On 3/14/2019 at 6:13 PM, lokipr said:

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.

I suspect "write-up" just means incident report. Incident reports are supposed to be completed for near-misses as well and their main purpose is to uncover systems errors.

Since many of us agree that the order was ambiguous, I think an incident report is in order to review the order itself. Doctors don't follow their own orders; they don't always realize how something is going to be implemented. Same with hospital pharmacies; while heading off one problem they don't always realize they're creating a different problem. The incident report calls attention to what might be a multi-faceted problem.

If many such reports are being written based on the actions of the OP it may highlight an education gap that needs to be addressed.

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It is not official but I often tell patients that I cannot give narcs within an hour of each other and I make it a point to check and chart the BP before the second narc.

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