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Family Physician
Family Physician, Doctor (MD)
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Experience:  Emergency Medicine and Family Practice for over 26 years
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I am an RN and wrote a set of orders that read as follows: 2/26/2013

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I am an RN and wrote a set of orders that read as follows:
2/26/2013 at 1225 Ok to access mediport.
TORB DR.-X/ No Name, RN

2/26/2013 at 1400 Dilaudid 1-2mg IM Q3-4hrs prn.

TORB DR. No Name/ No Name, RN

2/26/2013 at 1430 Dilaudid 1-2 mg IV Q3-4hrs prn.

TORB DR. No Name/ No Name, RN

The accronym TORB means telepone order read back. I was told that this order was confusing and could have caused a medication error. In my defense, I believe that any prudent nurse if they were uncomfortable with that order or any other order written by a nurse to be later signed by a physician would have called the physician to clarify. What is your opinion?

2/26/2013 at 1410
Thank you for your question:

Is TORB a standard abbreviation at your hospital?

Which particular order (or orders) are they saying are confusing?
Customer: replied 3 years ago.

Yes. TORB is standard at this hospital.


The confusing part was identified as the dilaudid orders. Specifically the concern was the person reading the order wouldn't know which one to use. If neither order was discontinued then it seems there is an option to use IM or IV.

Thank you:

There are in my opinion several issues with these orders:

The range of dose (1-2 mg) the choice of delivery option (IV and IM) and the range of time are issues. Generally, they order should be more specific; avoiding issues with the nurse "prescribing". For example: Dilaudid 1 mg IV q3h prn pain rating 5/10 to 8/10 and Dilaudid 2 mg IV q3h prn pain 9/10 -10/10 would eliminate this confusion.

There is no reason to use q3-4 hours. If the medication can be given every 3 hours, what is the reason for including the 4 hours. If the patient is not having pain in 3 hours or 4 hours, but does have pain in 5 hours from the last does, can you give this medication when it is written q3-4 hours?

 

There is nothing to direct the nurse in the selection of route; If the order was use IM if IV infiltrates, that could be less confusing.

Family Physician and 4 other Health Specialists are ready to help you
Customer: replied 3 years ago.

The orders were written based on previous orders that were written by a CRNP. The concern was brought up by another RN and an explanation as to why it was confusing was unclear to me until you gave me an explanation from a physician's point of view. Thank you.

I'm glad I could help. Thank you for the positive rating.