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Improving Patient’s Safety By Controlling The Doctor Orders For Ranged Dose Or Ranged Frequency.

Are you familiar with range orders for medications like MORPHINE 2-9MG IV Q6hr PRN at your facility? Does your hospital policy contains any restrictions on these orders?! And in case of a ranged order; how does the nurse determine the exact dose to be given and at which frequency?!

Where I work, we do allow them, and the nurse is giving all the needed training for pain assessment. We’re also using an electronic system, where prescriber must enter the required indication for each scenario. And not leaving the medication order prune to error and assumptions of the other healthcare staff.

Other hospitals might only allow one range... perhaps dose or maybe frequency! Yet, in both cases, the physicians must clearly enter the required dose range [i.e. for pain score 1-3 give 2MG, for pain scale 4-9 give 4MG …. etc.]

In some cases if the physician does not specify – the lowest dose and shortest frequency are used. A nurse must start at the lowest dose unless the patient has recently received a higher dose of the medication (or equivalent)

During the doctor's entry for the ranged order, they were using a free text field, and that doesn’t really help our clinical support system. That's why in most cases we had to verify the ranged doses manually and double checking them while dispensing and administration.

For orders with insulin doses from our insulin pumps and doses from our PCAs; ranged orders are required.

For non-pain medications, we instruct the nurse to start low and assess for effect, then proceed as necessary to address the condition.   Also have a Pain Management policy that guides the nurse to choose the pain order and dose that matches the pain score obtained from the assessment of the patient pain medication asks the prescriber to choose a Pain severity (mild, moderate or severe), all of which have scores assigned to them in the policy. For example, if the dose range is 1-2MG when mild pain, and the patient expressed the higher end of that range, then the nurse would choose 2MG.  If there are multiple products ordered, the nurse first picks the one attached to the pain score and then determines the dose which gives the nurse a guideline, but allows some flexibility in adjusting to the patient response.

Obaid

Pharmacist, CPHQ, CHQO, Quality Coordinator, Chemotherapy Preparation incharge. Graduated pharmacy school in 2009 I stood with my classmates as we recited the “Oath of a Pharmacist” in. There is one particular vow that stood out to me as we recited the Oath and I embrace this vow, “I will apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for my patients.” I love being a pharmacist because it allows me to use my knowledge, abilities, and talents to improve patient outcomes in the community hospital in which I am employed as the pharmacy clinical coordinator.

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