Q-Pap: A Story From the Trenches

This is a true story of badly worded orders, and mathematics.  Essentially, there was a patient who claimed he couldn't swallow pills, so one of my coworkers took a phone order for liquid Tylenol.  It looked something like this:

Give Q-PAP 15 mL PO TID PRN 150mg/5mL.  

COME ON!  Don't write down an order like this.  Never write an order in the form of:
drug name-volume-route-frequency, because concentrations vary.  What can happen is the next nurse, who is bleary eyed from pulling 3 days of double shifts, will read your sloppy handwriting and read any of the following:

Give Q-PAP 5 mL PO PRN 150mg/5mL (Translated: Q-PAP 150 mg PO TID PRN)

In which case, the patient will be screaming at you for more pain medications in 1/5 of the time.

Give Q-PAP 5 mL PO PRN 150mg/mL (Translated: Q-PAP 750 mg PO TID PRN)

Which is actually a reasonable dose in theory, but in reality it's wrong because the concentration given to you from the pharmacy is 150 mg/5mL and NOT 150mg/mL.

Or worse, you'll confuse yourself and end up transferring from the MAR to the POS incorrectly because you'll have confused yourself.  And you'll end up with an order like this: 

Give Q-PAP 15 mL PO PRN 150mg/mL  (Translated: Q-PAP 2,250 mg PO TID PRN)

In which case, the next shift will be tempted to call an ambulance because on first glance it looks like you gave your patient way too much Tylenol, and he will need a liver transplant.

Always write your orders down as: drug name-dosage (mg, mcg, etc.)-route-frequency.  So, let's take this jumble order and 1) solve for the correct dose, and 2) rewrite the order.**

Give Q-PAP 15 mL PO TID PRN 150mg/5mL
In other words: You are giving 15 mL of Tylenol at a concentration of 150mg/5mL.  How many mg are you giving?

15mL x 150mg
              5mL

=3x150mg

=450mg

The best way to write this order: Give Q-PAP 450mg PO TID PRN

                                                              drug      dosage route frequency 

**In real practice, you would have called the doctor to clarify the order.

Caveat: Some pharmacies, like Walgreens will need a quantity of medication (7 pills, 30 pills, 90 pills, etc.), and a duration (for a week, for a month, etc.) in order to carry out the order.