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Written Up

Nurses   (5,788 Views 103 Comments)
by medteleER medteleER (New Member) New Member

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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. 

 

 

 

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1,660 Likes; 4 Followers; 16,988 Visitors; 2,523 Posts

Well, how do you think you should be feeling about this?

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237 Likes; 7,864 Visitors; 725 Posts

Well ...

Do you think you double dosed the patient? Did you have questions RE: the order?

I would not have given both doses. The PRN is treating both - sleep and anxiety. Q8 is also key here. I don’t know the patient nor the specifics, but no: one PRN dose should have been given, not both.

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morelostthanfound has 25 years experience as a BSN and works as a R.N..

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I wouldn't have given both either, but I absolutely agree that this a confusing, poorly written order.  A clearer order would have been something like; Xanax 0.5 Mg by mouth, every 8 hours, as needed for anxiety/sleep.  

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Sour Lemon has 9 years experience.

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I'm not sure about the write up since there was no technical fault, at least as I see it. I would have spaced them out a little bit, though. Maybe the patient couldn't sleep because she was anxious ...or maybe she was anxious because she couldn't sleep. Giving the second dose after the first has had a chance to onset will help you avoid controversy in the future.

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Emergent has 25 years experience and works as a Emergency Room RN.

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You should have clarified these confusing orders by calling the doctor. If it annoys the doctor, well, he/she needs to be more careful when writing orders. 

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3 minutes ago, Emergent said:

You should have clarified these confusing orders by calling the doctor. If it annoys the doctor, well, he/she needs to be more careful when writing orders. 

This is why they get paid the big bucks. Never hesitate to call, OP ... it’s always better to clarify.

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TriciaJ has 35 years experience as a RN and works as a Retired.

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12 minutes ago, morelostthanfound said:

I wouldn't have given both either, but I absolutely agree that this a confusing, poorly written order.  A clearer order would have been something like; Xanax 0.5 Mg by mouth, every 8 hours, as needed for anxiety/sleep.  

Unless their pharmacy has some weird rule about putting two indications in the same order and insist each indication be its own separate order.  Hospital pharmacies make rules like that all the time, based on some previous misinterpreted order.

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morelostthanfound has 25 years experience as a BSN and works as a R.N..

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6 minutes ago, Sour Lemon said:

I'm not sure about the write up since there was no technical fault, at least as I see it. I would have spaced them out a little bit, though. Maybe the patient couldn't sleep because she was anxious ...or maybe she was anxious because she couldn't sleep. Giving the second dose after the first has had a chance to onset will help you avoid controversy in the future.

Agree with Sour Lemon on this-not technically a med error, just maybe a lapse in judgment, but let's face it-1.0 Mg of Xanax is not a whopping dose by any stretch of the imagination!

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Sour Lemon has 9 years experience.

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1 minute ago, morelostthanfound said:

Agree with Sour Lemon on this-not technically a med error, just maybe a lapse in judgment, but let's face it-1.0 Mg of Xanax is not a whopping dose by any stretch of the imagination!

I actually think the orders were very clear. What varies are unit culture and nursing judgement. 
I don't even think there was an "error" in judgement ...just a difference of opinion. If we're looking at facts, the OP was perfectly right.

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RNNPICU has 13 years experience.

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Technically yes, you did double dose the patient if you gave both at the same time.  The order should have been clarified as was the sleep dose only at night?  Likely they need both orders for daytime and night time.  The medication is the same regardless.  

I would have questioned the order.  Even if I gave the patient a dose at let's say the dose for sleep was due at 8pm.  I gave a patient a dose for anxiety at 6pm.  Since this med needs 8 hours spaced apart, I would question the MD.  

 

A quick search online reveals that a single dose is 0.25 - 0.5mg Q 8, you gave your patient 1mg in a single dose.

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Tenebrae has 6 years experience and works as a Registered Nurse in Gerontology.

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I would have given 0.5 to start with to see how the patient reacted. You can then follow it up later with another 0.5 if they are still anxious. 

 

While it is an unclear order, technically i can see how you could have given both and not double dosed, the key would have been ensuring you documented the hell out of it in the patient notes. 

EG Mrs Smith, given PRN xanax 0.5 for sleep. Further PRN xanax 0.5 also given as Mrs Smith stated "I feel anxious"

As they are both PRN orders it would have been quite appropriate to double check with the prescriber. Its helpful to know though what are the safe ranges, and if you did give both is it an appropriate amount. 

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