Home Forums Discussions General Discussion q4 to q6

OK, stupid topic but I have always wondered about this. This generally comes up with a narcotic, and we use it all the time for Tylenol with codeine po q4 to q6 hours.

It would be nice if 5 fit into a 24 day. But, isn't q4 to q6 confusing? Do we want the patient to use the medication q4 hours prn pain or q6 hours prn pain?

Are you locked into the built in directions for MU? I just type "Use up to 5 times a day prn pain", or any other english language equivalent. Sometimes the directions get even more convoluted, like sliding scale prednisone or tryptin use.

No, it just seems a lot of narcotics are written that way. Even Tylenol: 4 to 6. Motrin: 6 to 8. It must be confusing to the patients.

I also think it is confusing - I try to do plain english of 1 tab every 4 hours as needed for pain......ironically in hospital and nursing home EMRs they often hate ranges - Morphine 2-4 mg every 4-6 must be entered as Morphine 2 mg every 4 and Morphine 4 mg every 4 hours as well as Morphine 4 mg every 4 and another at every 6. This makes a lot of work for nurses entering and I think docs change their methods if they have to enter the orders.

I feel validated.

While we are on this, there was a post on the AC Facebook page about a forthcoming enhancement that would do something with the PDR I think to assure proper dosing and warnings? Can anyone explain what this is about? If it is as unhelpful as the current interactions, I can only see some new part of the e-Rx that demands we order medications only in the "approved" fashion.

Does anyone use a PDR for anything other than a monitor stand?

Maybe an obvious answer, but since you asked...I always thought that q4-6 hours left it up to the patient: if every 6 controls your pain, then leave it at that, but you CAN take it at a 4 hour interval if you need it.
A few years ago, the JCAHO came to our P and T committee and said that such "range orders" are to be avoided; they put the nurses in a position of making decisions about dosing, which is beyond their training. (That is JCAHO talking, not me). Personally, I still think think they are useful and sometimes prescribe that way.

David, here is the program you mention. It seems to simply be a program whereby AC (and other EHR's) are certified by the PDR as appropriate for prescribing. I saw the response from an AC rep on the Facebook page; it does not seem to jibe with the description of the program at all (?activated service; monthly fee?).
It would appear that the PDR's primary value as a doorstop or monitor stand is in no way endangered.

I hope this post leaves both Bert and David feeling validated. Maybe Steven, too.

Then why not 4 to 8 for the same reason? But, it does somewhat answer my question.

If you like 4-8, then go for it!

Stop being so argumentative; it could get you banned!

Technically, numbers below 10, should be written out.

The PDR works wonderfully for my 9 year old to sit on during piano lessons to get the appropriate posture for her lessons--