Reading the Order: Units, Abbreviations, and the Wrong Route
A handwritten order reads: 'Compazine 10 mg IM q6h PRN nausea.' The pharmacy sends a vial labeled 5 mg/mL. The PCT is asked by a nurse to 'give the 10' while the nurse is on the phone. The PCT has medication administration training limited to oral and topical routes under supervision; IM injections are outside the PCT's authorized scope at this facility. The patient is nauseated and has an IV line in place. The order is legible but uses the abbreviation 'q6h' and 'PRN,' and the vial concentration differs from the dose.
1. Identify every issue with this order and the request.
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Issues: (1) The PCT's scope does not include IM injections, so the request is out of scope regardless of the order. (2) The dose (10 mg) and concentration (5 mg/mL) require a calculation (2 mL), which is a high-risk step that should be verified by the administering licensed nurse. (3) 'Compazine' is a brand name; confirm the generic (prochlorperazine) and the ordered route matches the vial. (4) Abbreviations 'q6h' and 'PRN' are on the Joint Commission 'do not use' list in some contexts; 'q6h' should be written 'every 6 hours.' (5) The nurse delegating by phone without direct supervision is unsafe. The PCT should decline, state the scope limit, and ask the nurse to administer and verify.
2. What should the PCT say and do?
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State clearly: 'IM injections are outside my scope; I can't give this.' Offer to bring the vial, order, and MAR to the nurse, and to stay with the patient. Document the refusal to administer and the notification. Do not calculate or draw up the dose.