IV med dosing question

You have 2 orders for an IV pain med. One is for 1 mg Q4. The other is for 2 mg Q4. 1 mg is given and 2 hours later another 1 mg is given. Is this within the parameters for the dosing. The CNS wasn't sure and thought that it may be prescribing. How do you interpret it?
this is a situation in which you call the attending md and clarify the order. however the order states 1 or 2 mg q4, not 1mg q2...

If you have two different contradictory orders, you call the physician and clarify, in order to d/c one of the orders.I would not give the 2nd dose of the medication before clarifying.

Quote from luv2b_a_nursYou have 2 orders for an IV pain med. One is for 1 mg Q4. The other is for 2 mg Q4. 1 mg is given and 2 hours later another 1 mg is given. Is this within the parameters for the dosing. The CNS wasn't sure and thought that it may be prescribing. How do you interpret it?

Pharmacy was called and agreed that the 2nd mg can be given within the 4 hours. I would rather start a pt on 1 mg and give another later if necessary instead of going for 2 right away. We do it a lot for pills as well if 1 doesn't cut it. Does anyone have any rationale or policy on this?

Technically, I would say yes. But then again, aren't you practicing outside of your scope? You are saying that you would start the patient on 1 mg and give another if necessary. That is prescribing medications, unless you have specific orders. If pharmacy agrees, then I would let the pharmacist give the second mg personally until clarified, CYA.

This is a tough situation. I found myself wondering this same thing recently. I could give a small dose of a narcotic or a bigger dose. I told the family, "we should try the smaller dose now and we can always give it again and make it the bigger dose if it doesn't work." I think it was morphine 1mg or 2 mg q2h prn for pain. I don't know the right thing but I was willing to try the smaller dose and not wait out the 2 hours to give more.

Quote from rnccf2007Technically, I would say yes. But then again, aren't you practicing outside of your scope? You are saying that you would start the patient on 1 mg and give another if necessary. That is prescribing medications, unless you have specific orders. If pharmacy agrees, then I would let the pharmacist give the second mg personally until clarified, CYA.

Quote from luv2b_a_nursYou have 2 orders for an IV pain med. One is for 1 mg Q4. The other is for 2 mg Q4. 1 mg is given and 2 hours later another 1 mg is given. Is this within the parameters for the dosing. The CNS wasn't sure and thought that it may be prescribing. How do you interpret it?

Quote from ~*Stargazer*~However, with two distinct orders for the same medication, things get a little fuzzier. If you go by the 2mg q4hr order, then giving a second dose of 1mg within the four hour time frame would be acceptable, but when does the next 4 hour time frame start? From the time the first dose was given, or the time when the second dose was given?

Quote from luv2b_a_nursWell, I don't know that it *really* matters a ton when the next time frame starts as long as one does not give a total of more than 2 mg in 4 hours but I would go 4 hours from the time of the first dose.

Quote from rnccf2007Technically, I would say yes. But then again, aren't you practicing outside of your scope? You are saying that you would start the patient on 1 mg and give another if necessary. That is prescribing medications, unless you have specific orders. If pharmacy agrees, then I would let the pharmacist give the second mg personally until clarified, CYA.

Quote from luv2b_a_nursI don't believe so but having the pharmacist give the 2nd mg would be outside of THEIR scope! We as RNs are trained and are qualified to administer meds and use our critical thinking skills and judgement.