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A patient with a diagnosis of middle cerebral artery thrombosis was admitted to a medical unit. Because the patient couldn't speak, his son gave the admitting nurse the medical history, including medications the patient was taking. The nurse attached the list of medications and their dosages to the front of the patient's chart and handed it to the doctor.
Later that evening, the nurse reviewed the medication orders the doctor had written for this patient. She was surprised to see an order for digoxin (Lanoxin), 0.25 mg, q.i.d., when she clearly remembered the patient's son saying his father took Lanoxin only once a day. So she looked at the doctor's order again, confirmed that it said q.i.d., and transcribed it onto the medication Kardex.
Because the nurse was new on the unit, she asked the charge nurse to check the orders she'd transcribed. When the charge nurse saw the Lanoxin order, she too questioned it. Both nurses examined the doctor's written order again ... and agreed it said q.i.d. Nevertheless, the charge nurse was uncomfortable with the increased dosage and called the doctor for verification.
The doctor claimed he wrote q.d.-once daily-not q.i.d. But his order looked like this.
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The period after the “q” looked exactly like an “i”. Luckily for the patient, the order was corrected before a dose was given. If he'd received Lanoxin four times a day, he'd have developed digoxin toxicity and could have died.
This near-error could have been avoided if the doctor had written out the word daily on the medication order instead of using the abbreviation q.d. This is an unacceptable abbreviation. But the nurse compounded the doctor's error by transcribing what she knew was an unusually high dosage.
To avoid similar errors, be sure you know the dosages of the drugs you administer. Don't hesitate to ask the doctor to verify unusually high dosages. And work to eliminate the use of the abbreviation q.d. for daily.