What do you think of this Ambien order?

I could I also title this "Did I make a med error?"

I have a new skilled res with an Ambien order that reads: Ambien 5 mg po Take 1-2 tabs at HS prn

Twice in the last few weeks, I have given her one Ambien at about 2200 and then have found her still awake at around 2400 so I would give the second Ambien. I would never repeat the dose if she had been sleeping for a few or several hours. I mean how do you know if you need one or two Ambien when you're trying to get to sleep? Anyway, the day nurse threw a fit saying that I'd made a med error and now I"m just waiting to hear what the skilled supervisor thinks. The order is now going to be clarified so that it won't be an issue in the future but I'm interested to hear what you all think of this.... Do you think I made a mistake?
I can see why she thinks it is a med error, which is why my hospital does not allow orders like that. However, you stayed within the parameters of the order in my opinion.

I don't think you made an error. If it was prescribed to me personally the way it is written, I would take one and if I had not gone to sleep would take the second. On what grounds does the day shift think you made an error?

The order is flawed and I would have gotten clarification but no I don't think you made a med error. I give 10mg all the time so that wouldn't have raised any red flags. I'm surprised the day nurse would be nasty about this even though I think she is correct in wanting clarification.

I do not think you made an error.

You were technically within the parameters of the poorly written order. Should have had a clause of, give 1 and if not effective in 1 hr give another 5 mg. Or something to that effect.

Definately not a med error. Our Dr often orders pain meds like this, this way the patient can take 1 and if it works great, if not then they can have another. Of course if the pain med is Q4hrs, the 4hrs part starts when the second pill is given, and the second pill has to be given 1 hour after the first one, this way they can not be requesting a pain med every 2 hours.

Thanks for the input! I agree that it is a poorly written order that I should have had clarified from the beginning but I'm relieved to hear that you don't think its an error. This particular day nurse seems to be one who is always trying to catch the overnight nurses doing something wrong (superiority complex maybe?) Anyway, thanks again for the input!

The way the order is written is not an acceptable order in the state where I work. It must be written as "Ambien 5 mgm po qhs prn. May repeat x1 before 1 a.m. (or may repeat in 1 hour)." By giving the patient Ambien 10 mgm upfront (if you had done so), you are, in, essence, outside the scope of nursing practice because you have arbitrarily made the decision of how much Ambien to give. Therefore, you are considered to be "prescribing" medication. When you repeat the medication after giving the 1st dose, you have made this decision based on your nursing assessment. Don't forget to document your assessment! Years ago, it was standard practice to have orders such as this: Morphine 5-8 mgm sc q 3 hrs prn pain. Now the order has to be written using the pain scale:Morphine 5 mgm pain 4-5, etc.. It is not within the scope of nursing practice to decide the dosage arbitrarily. This has been mandated by the state Dept. of Public Health and the Nursing Board of Examiners.

Not a med error.

Quote from scoochyThe way the order is written is not an acceptable order in the state where I work. It must be written as "Ambien 5 mgm po qhs prn. May repeat x1 before 1 a.m. (or may repeat in 1 hour)." By giving the patient Ambien 10 mgm upfront (if you had done so), you are, in, essence, outside the scope of nursing practice because you have arbitrarily made the decision of how much Ambien to give. Therefore, you are considered to be "prescribing" medication. When you repeat the medication after giving the 1st dose, you have made this decision based on your nursing assessment. Don't forget to document your assessment! Years ago, it was standard practice to have orders such as this: Morphine 5-8 mgm sc q 3 hrs prn pain. Now the order has to be written using the pain scale:Morphine 5 mgm pain 4-5, etc.. It is not within the scope of nursing practice to decide the dosage arbitrarily. This has been mandated by the state Dept. of Public Health and the Nursing Board of Examiners.

Hi IowaLPN, Just by looking at the way it was written, you had 2 choices, either 1 pill or 2 pills at HS. If your hospital's HS time is 2200, then that is when she receives her medication. If by 2400, she is still not asleep, then the doctor needs to be called for a new order. The doctor did not set any parameters for this medication. Just my opinion...from a nursery LVN.

scoochy is right on target. Any order giving ambiguous parameters puts us on the hot seat. Orders should be written for ONE drug, One amount and ONE time interval-the Nursing office should back you up on this by making it a rule for us nurses to follow, and they should get after the doctors who don't prescribe correctly.