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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.
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.