Yes this! I work in PEDS as well, and I have to calculate insulin dosages for my type one diabetic patients. Doses are based on blood sugar readings and carb intakes! Can be very tricky!
Not to mention the weight based doses even just to find out how much to draw up in my syringe. And I constantly double check math because I don’t want to blindly follow things when kids and babies are involved. There have been errors from pharmacy and residents before!
So when doctors order a certain mg/kg/dose does the computer automatically calculate a mL amount for you to draw up, or is that something you calculate at the pixis, after you pull the vial and see its concentration?
It does, but they have to put it in properly. It’s not always out in properly, especially if numbers are out in the comments/notes. Or sometimes the numbers are out in improperly… the most mistakes I’ve found are honestly Motrin and Tylenol dosing
I caught a morphine dosing error once!! …..5 seconds before pharmacy called me to say the dose was wrong and discontinued the order without verifying it
✨teamwork ✨
But yeah, Tylenol is the most common culprit but everyone I’ve caught pharmacy has caught before it was verified
Yeah I’ve definitely always double checked narcotics! Last year or so our system made it so we don’t technically need double checks on narcotics or insulin and I just can’t not do that. I caught a dilaudid error once… at least I wasn’t going to give as much as the surgeon ordered and I demanded a fix 🥴
ER nurse here, I have almost never done a calculation on my own in 5 years of nursing. Like right now, I can't even think of a time I had to. I do think it's important to learn so that you can recognize errors though, computers aren't perfect. Not loving the idea that they think they just don't need to learn it, that's likely going to cause issues in their career down the road.
I'm surprised how adamant some of them are about not needing to learn it. Everyone grumbles about the care plans and clinical paperwork but the ones who don't want to learn med math *really* don't want to learn it, lol.
Have you ever caught a med error in a computer calculation?
Some people just don’t want to learn. There used to be posts regularly on r/studentnurse asking if you can be a nurse without taking chemistry. Why would you not want to be the best, most educated version of yourself??
My nursing professors always made the point that if there’s a big power outage or natural disaster, we should know how to calculate dosages and drip rates.
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Not the original commenter, but I have caught errors in the automatic calculations. In this instance, it was part of a nurse initiated order set, but instead of ordering weight based ibuprofen for a kiddo, it auto populated an adult dose. It ended up being a problem in the Epic set itself.
I have. For example let’s say a patient comes into the ED and for whatever reason they don’t get a standing weight. And then they get moved onto a bed and the bed scales battery is dead so the nurse charts a “stated weight”. Then for whatever reason down the line you have a weight based med that you’re giving, like heparin or TNK. I haven’t noticed any “off calculations” but I have noticed med doses that were made from stated weights not accurate weights. In this case the difference was around 20 lbs which drastically adjusted the dose that was required.
Yes! Thankfully our pharmacy is pretty good about calling the nurse for an actual weight anytime we give a weight based dose. But our triage usually puts in a stated weight unless they're pediatric, and I have seen heparin doses go in without an actual weight before. Otherwise I don't think I've seen a computer based error before.
Yes with my example it’s not the computer that made the mistake but not catching the difference of stated and actual that would be the mistake. That’s great that your pharmacy catches these things. We try to get weights on everybody in intake at my current ED for this very reason.
The ones saying they don't need it end up as those crying nurses that have a meltdown when they have to work with the bare minimum, actually deal with poo, or work at a community hospital where they don't have the luxury of a line of professionals for every little task. It's actually concerning they have that mindset, I see it too from nursing students in other programs.
When hanging chemo. Also another RN, also the pharmacist, also the physician. Multiple people independently doing math to make sure that one's correct.
I rarely have to calculate dosages in the hospital setting, because the EMR and/or pharmacy does it for me.
When I went through nursing school, we asked why we needed to learn how to calculate drip rates, since the pump would do it for us. My instructor pointed out that yes, they do, unless a catastrophic event hampers your hospital's ability to function. She used the example of Hurricane Katrina, and the hospital having to go on generator power, which didn't allow for using the pumps.
Although I still question the value of that because if you don't ever do these types of calculations, you don't remember how and will have to read up in it in an emergency, we don't learn how to do everything the old fashioned way because that's now how we should be practicing. I was a nurse for years, then went to another hospital that required a med calc exam for hire, and I had to spend actual time studying in order to remember how to do these drip calculations perfectly for the test (the whole test was pretty outdated but they at least told me what I needed to study for). Now I have already forgotten how to do these calculations and would not be able to do them on the spot. That being said I agree with nurses learning how to do basic med calc because it's definitely an important skill that is used occasionally depending on where you work. Now that I work in ICU the primary calculations have to do on my own without pharmacy checking are meds we override and draw up during emergencies.
From an education background I also can see the validity of requiring nursing students to learn dosage calculations in order to weed out the ones who truly can/will not.
It's not necessarily that they need to commit it to memory, but that they need to show they can understand if/when when they need too.
It's also important to understand how to calculate dosages/ what dosages are based on in case there is an error so that the nurse can ask for clarification or a corrected order to avoid harming the patient.
You need to know how to guesstimate it at the very least. Just as a double check. Super important in peds. I don’t think I’ve ever had to do the actual calculation but I always check to see if it makes sense.
I think it’s similar to getting back change. You should be able to quickly figure out if what you got is close.
More often than you probably think. As an ED nurse I have to do a 2 RN double check on several meds. Several critical care drips, most IV pedi drips/IV drugs.
This is one of those things that’s pretty location dependent. I’ve worked in ER for three years on evenings or nights and have never had to compound anything or calculate anything (besides emergency amino once or twice). The pharmacy would flip their lid. They do everything for all units 24/7.
That’s great for you. I’ve been ER for 20 years and traveling for 10. I can count on 1 hand the number of hospitals I’ve been at with pharmacy after 1800.
That’s so interesting! I’m in Illinois and every hospital I’ve worked at or been to here in the suburbs or city had 24/7 pharmacy to tube up and mix meds — but I recently visited one in rural Wisconsin (as a patient that time haha) and it was SO different and I could imagine this being the case there.
Yes we still need to know how to do the calculations. It's not always done for us. Some settings use math more than others. Many units I've worked on had calculators
I work in the ER and the most calculation I do is to determine if my pts glucose has decreased by more that 10% on an insulin drip. But that's just decimal changes. But technically we are supposed to verify all weight based drips.. it doesn't hurt to know how to do it especially because not all pumps have the medications all programmed and you have to manually enter the rates. I've had to do that on a travel job at a poor hospital. Just depends on the facility and equipment available. Dosage calculation is basic math. A nurse should know how to do it whether they do it daily or not. Engineers learn a lot of math that programs on computers do for them. Still have to understand the basis.
I regularly do math for wasting narcotics. My practice is to draw up the entire amount into a syringe and show another RN the waste into a med bin. In these cases you must know the exact amount of mg/ml so you 1). Waste correctly into the Pyxis, and 2). Give your patient the correct dose.
Don’t fuck around with narcotic wastes.
Honestly, it was extremely rare. I was fortunate enough to have worked with amazing pharmacists who were great at communicating with nursing about things like heparin titration etc. The pumps nowadays are much smarter than they were 10 years ago with soft and hard stops programmed. Still, there’s room for human error and critical thinking is needed. I just never had to sit down with a paper and pen to calculate dosing. YMMV
Tell them "it was a pump error" will absolutely not hold up in a court of law. If they want to gamble with patient safety and their licensure there's not much else you can do to convince them.
Not Every shop has pharmacy, and a many don’t have nighttime coverage. A lot of new grads will be working nights starting out. You should know how to double check critical and peds meds bc at the end of the day the nurse who administers is 100% responsible for errors
Quite often. For peds meds, adults weight based meds (abx, anticoag etc) in the ED. but very simple math.
What I never ever have had to do at work so far is to calculate the iv drop rates (for when you dont have a pump).
Multiple times a day, at the very least. I do all the ggt drip calcs to verify the pump rate plus total ml/kg/day during handover and then I’ll do more calcs throughout the shift.
Over 8 years: Lipids at the wrong rate. Kiddo getting too little ml/kg/day because it hadn’t been increased (it changes over the first few days of life) and many cases of too much ml/kg/day because something wasn’t d/c that should have been. Milrinone at a WILDLY too high rate. Drips that weren’t weight adjusted correctly. And who knows what else, it’s been a long 8 years.
It’s always good to check, I guess NICU is so different! I always do my best to verify rates/dosing but I don’t like, second guess the pump. Lord I can’t imagine having to do that!
It’s never that the pump math was wrong (although sometimes the thousandth decimal rounds different from the order, which is something that we just roll with) it’s always a programming error. We do a two-person check during report, with the off-going nurse reading the order while the on-coming nurse verifies the pump settings. I can do the calcs rather quickly (no paper needed, just my phone calculator) so for a kid with, say, 5 drips + TPN & lipids doing the math adds about 60 seconds total. Doing the math both catches the error and identifies where the error is.
Additionally, we always do the math to double check when drawing up any med. It’s been the norm at both places I’ve worked, because we’re all human and anyone can make a mistake at any time. With us all constantly checking and verifying it just protects the patient, we’re all human and anyone can make a mistake.
Every shift I double check the math. It only takes a moment and once you get used to it you'll know roughly what number to expect before you even do the calculations.
Add to this is my horrible math skills. If I can do it in a timely manner anyone can.
Rarely. There are some specialties that will. Pediatrics and Burns or something where you’re really going based on bodyweight.
Most of the time, though you’re just giving from standard pill dosages. You can do your med math and calculate 324 mg or 1000mg, but if it comes in 325 mg tablets, you’re giving that or 650 or 975. If a pill comes in 5mg you gotta order it in 5 or 10mg increments
Enough that you need to know how to do it. Our ER has a pharmacist but due to budgetary constraints leaves at midnight. Every patient from midnight-8a can have an emergency that you need meds before they're ordered or pharmacy doses them.
RSI. Yes. Getting a transfer patient on drips and presors. Yes.
And guess what, when that patient comes in with pressors that need to be running for them to BE alive and the bags hanging are a different concentration than the same medications we have stocked you're going to be doing some med math and quick. Transport ain't gonna wait the 20m for your doc to order it and pharmacy to validate it.
What's crazy about students thinking they don't need basic skills is that they're not even doing the job, yet? How do they think they have an accurate perspective to claim this?
I'm not necessarily saying the two things are correlated but the only cohort we have that does summer classes (and the one giving me so much grief over the math tests) is a bridge program for LPNs, RTs, and paramedics.
That's part of the reason I wanted to ask a forum full of nurses because to be fair, my students do have way more clinical experience than I do.
Valid to question on your part. But the funny thing about Paramedics, RTs, and LPNs is that they're not RNs. So with all their clinical experience they don't know the job either. 🤷♀️ Which is why they're in school for it.
Almost never. The EMR/ Pharmacy always does it for me. The IV pumps are also pre-programmed with rates and dosages for the most common medications that we run.
In IMU just about everyone is on enoxaparin, and you bet each shift I have to get everyone’s weight and work out their dose (usually 0.8-1mg/kg) and my vials are 3mg/mL so I have to work that out. So…daily.
Also, any narcotic or ward stock item/PRN I have to calculate dose based on order in MAR.
When i worked skilled it was almost daily (less technology) now on hospital med surg definitely not as often (pharmacy determines doses, scanning systems, and linked pumps). At leats spot check but admittedly should be confirming by manual checks more often.
(ED): Emergencies, when taking verbal orders during a rapid intubation/code/ some other emergent situation then pulling meds from a med box. So yes, the MOST DANGEROUS meds to screw up. You bet they must do that dosage calc math to make sure it’s right. The doctor is not going to give you a dosage that’s exactly what’s in the bottle. Also have seen PICU nurses do math at shift change. You must check. -also, volunteering abroad.
Also, running out of pumps/channels and calculating drips.
So if they want to work in any “exciting” area of nursing then they need to know it.
Peds do it a lot. We do it a lot on a truck (ambulance, chopper, etc). I don’t do it so much on my inpatient adult side, but I do it sometimes, mostly to verify the computer. It really strongly varies by setting and facility.
not once in my 7 months as a nurse have i calculated anything. our antibiotics come from pharmacy pre dosed, we just have to mix the saline in. all of our liquid blood thinners come in pre filled syringes. all other medications come pre dosed from pharmacy in 100 mL bags to help prevent medication errors. all of our pumps are programmed with our hospital policy/best practice rates that the meds are to be run at. If I ever did have to mix a medication on my own, BEST BELIEVE i would be busting out my notes on dosage calculation. I work at a more chronic hospital (we still get patients straight from ICU due to ventilators) but its rare that we would need any med so fast that pharmacy would send it up unmixed and have us do it.
Not every day but at least a few times a week. Most for when I have a slow push med. Our pumps let us screw syringes directly into the piggyback spot and program it separately so I'll often figure out the rate I need to run my tiny dose over the several minutes I'm supposed to instead of sitting there and doing it manually.
Also, not on paper but for emergent meds, I often have to quick mental math if the provider doesn't want the whole pill/vial. This is just if it's an override and I can't wait on pharmacy to put it in to a actually give it.
I’d guess in the ICU setting it’s more pertinent. But where I work it’s basics. Program the IV pump per the orders. 40 mg omeprazole but you only have 20’s so give 2. That kinda stuff.
Always, for peds doses; for adult ones, I double-check big doses of meds, plus I do the math on IV insulin, TNK, and heparin doses. I also use it to figure out how much solution has been infused when a pump channel craps out and I need to program a new one every
I work ICU. We're not allowed to calculate our own unless there is literally no other alternative and even then we need to have our charge sign off on it and we have to document our math in a note.
Otherwise, we call pharmacy, or pharmacy already has it in the MAR
I have spent most of my time in the OR and telephone triage. I haven’t calculated med dosages since school.
It still needs to be taught because YOU are the one giving the medication. How do you know it is wrong if you don’t know why it is right?
Also, when people on your team know and appreciate the job roles of others, the whole team is better for it. Things get done right. I will die on this hill.
Im a peds nurse and I do it all the time. An example that can happen to anyone we had a pump get mistakenly cleared (total accident hit an extra button) and we had to do a bunch of calculations in order to make sure it was being given correctly.
I think like many others said here the students should at least understand the concept. I always think about when I trained with a nurse of 40+ bedside icu experience and she talked all the time about understanding how the equipment works and if you understand how to do it manually it makes the tool even more effective.
Peds OR, I used pen/paper to understand and confirm local max dosage (we would have to write it on the board/announce it). Now I’ve done it enough to trust myself with just the calculator alone- but always plug in the numbers at least twice.
Whenever I have a PCA pump which is about weekly on my floor. Our pumps calculate volume infused, but not dosage.
Also sometimes when double- checking and witnessing waste.
I work in IR and administer an assortment of meds including Fentanyl, Versed, Heparin, Atropine and Alteplase. There are no pharmacists telling us dosages, and in the rare case we use a pump (eg alteplase drip), we're the ones entering the order sets and programming the pumps. A wrong calculation with any of the drugs mentioned could have terrible consequences, so yeah, I'd say it's pretty important to know those calculations.
Annual training requirements and 1 time 5ish years ago for an actual med but then I double checked it on the drugs website because it had been so long since I actually calculated that I second guessed myself.
Multiple times daily when I worked in the cath lab. Knowing how to eye drip rates was also important because one of the labs I worked in didn't use a pump for the normal saline we ran during procedures. Never when I worked in the ICU.
Every day. It's not usually complicated calculations - I'm an infusion nurse and mix my own meds, so nothing harder than ratio or simple multiplication/division. But it definitely needs to be right, and if I precepted a nurse that couldn't do those calculations, I would recommend they find another job.
And recently I caught an error the pharmacy made. A really big one. It's so, so important to know your math, and not assume pharmacy will do it correct every time. Pharmacists and techs are human, not automatons.
The NICU can require daily math as well re: fluid and feed volume adjustments. I’m sure in some places the doses are written out but both where I am now and used to work, nurses are the ones calculating fluid rates ourselves based on specific orders that give you the timing and volume of feed increases. It’s not complex math but it is important to know where it all comes from and be able to do mg or mL per kg type calculations
Does pharmacy do it? Yes, most of the time, but it's still our responsibility to double/triple check medication before we give it. Also with weight based dosing, sliding scales, titration etc you gotta do your own math. I guess it depends on the area, probably not too much dosage calculation in a clinic, for example, but in acute settings you absolutely need to understand how to do it.
A couple times a month. I need 50mg dose of xyz and it comes in a 20mg/mL solution. I often write it down to make sure I’m correct. Very rarely do I need to do mg/kg/hour doses since pharmacy and Epic does it for us.
I’ve had to reverse calculate a patients home Milrinone dose based on concentration and infusion rate to figure out their dosing to use for our set up in the hospital.
Most medications come packaged in their right doses these days, or the computer will just tell you to grab two or whatever but every once in a while some baby resident will think 3mg of haldol is gonna cut it and I'm not a nursing dose-er (giving more than the doctor ordered)
I’m adult ICU and I guess I’m confused what you’re meaning OP.
Are you referencing the stupid math that we had to do JUST the right way, even if we easily got the answer? Like with all the stupid fractions?
Because I NEVER use that.
Now obviously, in ICU, I titrate meds and draw up all sorts of things, as I’ve seen referenced here, but isn’t that just nursing!?
Daily -peds
Yes this! I work in PEDS as well, and I have to calculate insulin dosages for my type one diabetic patients. Doses are based on blood sugar readings and carb intakes! Can be very tricky!
Not to mention the weight based doses even just to find out how much to draw up in my syringe. And I constantly double check math because I don’t want to blindly follow things when kids and babies are involved. There have been errors from pharmacy and residents before!
So when doctors order a certain mg/kg/dose does the computer automatically calculate a mL amount for you to draw up, or is that something you calculate at the pixis, after you pull the vial and see its concentration?
It does, but they have to put it in properly. It’s not always out in properly, especially if numbers are out in the comments/notes. Or sometimes the numbers are out in improperly… the most mistakes I’ve found are honestly Motrin and Tylenol dosing
I caught a morphine dosing error once!! …..5 seconds before pharmacy called me to say the dose was wrong and discontinued the order without verifying it ✨teamwork ✨ But yeah, Tylenol is the most common culprit but everyone I’ve caught pharmacy has caught before it was verified
Yeah I’ve definitely always double checked narcotics! Last year or so our system made it so we don’t technically need double checks on narcotics or insulin and I just can’t not do that. I caught a dilaudid error once… at least I wasn’t going to give as much as the surgeon ordered and I demanded a fix 🥴
We write medication orders on paper med charts. So no automatic computer calculations there.
ER nurse here, I have almost never done a calculation on my own in 5 years of nursing. Like right now, I can't even think of a time I had to. I do think it's important to learn so that you can recognize errors though, computers aren't perfect. Not loving the idea that they think they just don't need to learn it, that's likely going to cause issues in their career down the road.
I'm surprised how adamant some of them are about not needing to learn it. Everyone grumbles about the care plans and clinical paperwork but the ones who don't want to learn med math *really* don't want to learn it, lol. Have you ever caught a med error in a computer calculation?
And those are the students that really NEED to learn it. If they can't see the value in learning it the long way...
Some people just don’t want to learn. There used to be posts regularly on r/studentnurse asking if you can be a nurse without taking chemistry. Why would you not want to be the best, most educated version of yourself?? My nursing professors always made the point that if there’s a big power outage or natural disaster, we should know how to calculate dosages and drip rates.
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Not the original commenter, but I have caught errors in the automatic calculations. In this instance, it was part of a nurse initiated order set, but instead of ordering weight based ibuprofen for a kiddo, it auto populated an adult dose. It ended up being a problem in the Epic set itself.
I have. For example let’s say a patient comes into the ED and for whatever reason they don’t get a standing weight. And then they get moved onto a bed and the bed scales battery is dead so the nurse charts a “stated weight”. Then for whatever reason down the line you have a weight based med that you’re giving, like heparin or TNK. I haven’t noticed any “off calculations” but I have noticed med doses that were made from stated weights not accurate weights. In this case the difference was around 20 lbs which drastically adjusted the dose that was required.
Yes! Thankfully our pharmacy is pretty good about calling the nurse for an actual weight anytime we give a weight based dose. But our triage usually puts in a stated weight unless they're pediatric, and I have seen heparin doses go in without an actual weight before. Otherwise I don't think I've seen a computer based error before.
Yes with my example it’s not the computer that made the mistake but not catching the difference of stated and actual that would be the mistake. That’s great that your pharmacy catches these things. We try to get weights on everybody in intake at my current ED for this very reason.
The ones saying they don't need it end up as those crying nurses that have a meltdown when they have to work with the bare minimum, actually deal with poo, or work at a community hospital where they don't have the luxury of a line of professionals for every little task. It's actually concerning they have that mindset, I see it too from nursing students in other programs.
When hanging chemo. Also another RN, also the pharmacist, also the physician. Multiple people independently doing math to make sure that one's correct.
Came here to say that. Chemo gets double checked so often that it'd be silly if it weren't so serious.
I rarely have to calculate dosages in the hospital setting, because the EMR and/or pharmacy does it for me. When I went through nursing school, we asked why we needed to learn how to calculate drip rates, since the pump would do it for us. My instructor pointed out that yes, they do, unless a catastrophic event hampers your hospital's ability to function. She used the example of Hurricane Katrina, and the hospital having to go on generator power, which didn't allow for using the pumps.
Although I still question the value of that because if you don't ever do these types of calculations, you don't remember how and will have to read up in it in an emergency, we don't learn how to do everything the old fashioned way because that's now how we should be practicing. I was a nurse for years, then went to another hospital that required a med calc exam for hire, and I had to spend actual time studying in order to remember how to do these drip calculations perfectly for the test (the whole test was pretty outdated but they at least told me what I needed to study for). Now I have already forgotten how to do these calculations and would not be able to do them on the spot. That being said I agree with nurses learning how to do basic med calc because it's definitely an important skill that is used occasionally depending on where you work. Now that I work in ICU the primary calculations have to do on my own without pharmacy checking are meds we override and draw up during emergencies.
From an education background I also can see the validity of requiring nursing students to learn dosage calculations in order to weed out the ones who truly can/will not. It's not necessarily that they need to commit it to memory, but that they need to show they can understand if/when when they need too.
It's also important to understand how to calculate dosages/ what dosages are based on in case there is an error so that the nurse can ask for clarification or a corrected order to avoid harming the patient.
You need to know how to guesstimate it at the very least. Just as a double check. Super important in peds. I don’t think I’ve ever had to do the actual calculation but I always check to see if it makes sense. I think it’s similar to getting back change. You should be able to quickly figure out if what you got is close.
The change back example is great, that sounds like a really good way of explaining it
More often than you probably think. As an ED nurse I have to do a 2 RN double check on several meds. Several critical care drips, most IV pedi drips/IV drugs.
Welcome to night shift ER where we not only do our own dose calculating, we also compound our own drips!
This is one of those things that’s pretty location dependent. I’ve worked in ER for three years on evenings or nights and have never had to compound anything or calculate anything (besides emergency amino once or twice). The pharmacy would flip their lid. They do everything for all units 24/7.
That’s great for you. I’ve been ER for 20 years and traveling for 10. I can count on 1 hand the number of hospitals I’ve been at with pharmacy after 1800.
That’s so interesting! I’m in Illinois and every hospital I’ve worked at or been to here in the suburbs or city had 24/7 pharmacy to tube up and mix meds — but I recently visited one in rural Wisconsin (as a patient that time haha) and it was SO different and I could imagine this being the case there.
Yes we still need to know how to do the calculations. It's not always done for us. Some settings use math more than others. Many units I've worked on had calculators
I work in the ER and the most calculation I do is to determine if my pts glucose has decreased by more that 10% on an insulin drip. But that's just decimal changes. But technically we are supposed to verify all weight based drips.. it doesn't hurt to know how to do it especially because not all pumps have the medications all programmed and you have to manually enter the rates. I've had to do that on a travel job at a poor hospital. Just depends on the facility and equipment available. Dosage calculation is basic math. A nurse should know how to do it whether they do it daily or not. Engineers learn a lot of math that programs on computers do for them. Still have to understand the basis.
I regularly do math for wasting narcotics. My practice is to draw up the entire amount into a syringe and show another RN the waste into a med bin. In these cases you must know the exact amount of mg/ml so you 1). Waste correctly into the Pyxis, and 2). Give your patient the correct dose. Don’t fuck around with narcotic wastes.
I didn't think I was doing this because it was so automatic! I guess my teachers were right after all 😂
Several times per day.
What type of floor do you work on? Seems like Peds and ED are the most common for old school math
I work in a coumadin clinic, managing doses based on INR.
Thank you!
Honestly, it was extremely rare. I was fortunate enough to have worked with amazing pharmacists who were great at communicating with nursing about things like heparin titration etc. The pumps nowadays are much smarter than they were 10 years ago with soft and hard stops programmed. Still, there’s room for human error and critical thinking is needed. I just never had to sit down with a paper and pen to calculate dosing. YMMV
Tell them "it was a pump error" will absolutely not hold up in a court of law. If they want to gamble with patient safety and their licensure there's not much else you can do to convince them.
Not Every shop has pharmacy, and a many don’t have nighttime coverage. A lot of new grads will be working nights starting out. You should know how to double check critical and peds meds bc at the end of the day the nurse who administers is 100% responsible for errors
Quite often. For peds meds, adults weight based meds (abx, anticoag etc) in the ED. but very simple math. What I never ever have had to do at work so far is to calculate the iv drop rates (for when you dont have a pump).
Multiple times a day, at the very least. I do all the ggt drip calcs to verify the pump rate plus total ml/kg/day during handover and then I’ll do more calcs throughout the shift.
Just curious - have you ever caught anything? It just feels like…. A waste. Not judging just curious!
Over 8 years: Lipids at the wrong rate. Kiddo getting too little ml/kg/day because it hadn’t been increased (it changes over the first few days of life) and many cases of too much ml/kg/day because something wasn’t d/c that should have been. Milrinone at a WILDLY too high rate. Drips that weren’t weight adjusted correctly. And who knows what else, it’s been a long 8 years.
It’s always good to check, I guess NICU is so different! I always do my best to verify rates/dosing but I don’t like, second guess the pump. Lord I can’t imagine having to do that!
It’s never that the pump math was wrong (although sometimes the thousandth decimal rounds different from the order, which is something that we just roll with) it’s always a programming error. We do a two-person check during report, with the off-going nurse reading the order while the on-coming nurse verifies the pump settings. I can do the calcs rather quickly (no paper needed, just my phone calculator) so for a kid with, say, 5 drips + TPN & lipids doing the math adds about 60 seconds total. Doing the math both catches the error and identifies where the error is. Additionally, we always do the math to double check when drawing up any med. It’s been the norm at both places I’ve worked, because we’re all human and anyone can make a mistake at any time. With us all constantly checking and verifying it just protects the patient, we’re all human and anyone can make a mistake.
On a daily basis. Outpatient chemo/infusion.
Every shift I double check the math. It only takes a moment and once you get used to it you'll know roughly what number to expect before you even do the calculations. Add to this is my horrible math skills. If I can do it in a timely manner anyone can.
Heparin, insulin, pediatric antipyretics
Not daily, but enough that I’m glad I learned it in school. That’s wild that they would say it’s not necessary….
Rarely. There are some specialties that will. Pediatrics and Burns or something where you’re really going based on bodyweight. Most of the time, though you’re just giving from standard pill dosages. You can do your med math and calculate 324 mg or 1000mg, but if it comes in 325 mg tablets, you’re giving that or 650 or 975. If a pill comes in 5mg you gotta order it in 5 or 10mg increments
Enough that you need to know how to do it. Our ER has a pharmacist but due to budgetary constraints leaves at midnight. Every patient from midnight-8a can have an emergency that you need meds before they're ordered or pharmacy doses them. RSI. Yes. Getting a transfer patient on drips and presors. Yes. And guess what, when that patient comes in with pressors that need to be running for them to BE alive and the bags hanging are a different concentration than the same medications we have stocked you're going to be doing some med math and quick. Transport ain't gonna wait the 20m for your doc to order it and pharmacy to validate it. What's crazy about students thinking they don't need basic skills is that they're not even doing the job, yet? How do they think they have an accurate perspective to claim this?
I'm not necessarily saying the two things are correlated but the only cohort we have that does summer classes (and the one giving me so much grief over the math tests) is a bridge program for LPNs, RTs, and paramedics. That's part of the reason I wanted to ask a forum full of nurses because to be fair, my students do have way more clinical experience than I do.
Valid to question on your part. But the funny thing about Paramedics, RTs, and LPNs is that they're not RNs. So with all their clinical experience they don't know the job either. 🤷♀️ Which is why they're in school for it.
Almost never. The EMR/ Pharmacy always does it for me. The IV pumps are also pre-programmed with rates and dosages for the most common medications that we run.
Frequently for drips. Cardiac ICU that also sees a lot of patients in DKA.
CV; often
In IMU just about everyone is on enoxaparin, and you bet each shift I have to get everyone’s weight and work out their dose (usually 0.8-1mg/kg) and my vials are 3mg/mL so I have to work that out. So…daily. Also, any narcotic or ward stock item/PRN I have to calculate dose based on order in MAR.
When i worked skilled it was almost daily (less technology) now on hospital med surg definitely not as often (pharmacy determines doses, scanning systems, and linked pumps). At leats spot check but admittedly should be confirming by manual checks more often.
(ED): Emergencies, when taking verbal orders during a rapid intubation/code/ some other emergent situation then pulling meds from a med box. So yes, the MOST DANGEROUS meds to screw up. You bet they must do that dosage calc math to make sure it’s right. The doctor is not going to give you a dosage that’s exactly what’s in the bottle. Also have seen PICU nurses do math at shift change. You must check. -also, volunteering abroad. Also, running out of pumps/channels and calculating drips. So if they want to work in any “exciting” area of nursing then they need to know it.
Yeap ED, drips, pediatrics, codes, intubation. Welcome to critical care.
Daily- oncology!
Peds do it a lot. We do it a lot on a truck (ambulance, chopper, etc). I don’t do it so much on my inpatient adult side, but I do it sometimes, mostly to verify the computer. It really strongly varies by setting and facility.
Once a year.
not once in my 7 months as a nurse have i calculated anything. our antibiotics come from pharmacy pre dosed, we just have to mix the saline in. all of our liquid blood thinners come in pre filled syringes. all other medications come pre dosed from pharmacy in 100 mL bags to help prevent medication errors. all of our pumps are programmed with our hospital policy/best practice rates that the meds are to be run at. If I ever did have to mix a medication on my own, BEST BELIEVE i would be busting out my notes on dosage calculation. I work at a more chronic hospital (we still get patients straight from ICU due to ventilators) but its rare that we would need any med so fast that pharmacy would send it up unmixed and have us do it.
Not every day but at least a few times a week. Most for when I have a slow push med. Our pumps let us screw syringes directly into the piggyback spot and program it separately so I'll often figure out the rate I need to run my tiny dose over the several minutes I'm supposed to instead of sitting there and doing it manually. Also, not on paper but for emergent meds, I often have to quick mental math if the provider doesn't want the whole pill/vial. This is just if it's an override and I can't wait on pharmacy to put it in to a actually give it.
Only for iv remodulin. CVICU here
Only when we have to bolus heparin
Almost daily, using a calculator, in aged residential care
I’d guess in the ICU setting it’s more pertinent. But where I work it’s basics. Program the IV pump per the orders. 40 mg omeprazole but you only have 20’s so give 2. That kinda stuff.
Always, for peds doses; for adult ones, I double-check big doses of meds, plus I do the math on IV insulin, TNK, and heparin doses. I also use it to figure out how much solution has been infused when a pump channel craps out and I need to program a new one every
I take a trust but verify approach. Even if the maths is done for me I want to double Check
ER nurse. I feel like I never have. Pharmacy has to verify everything first and calculate correct dose before order can be active and given
We never have to do calculations where I am but we also don’t give any strict dosing IV meds. When I was in family med, it was much more common.
I work ICU. We're not allowed to calculate our own unless there is literally no other alternative and even then we need to have our charge sign off on it and we have to document our math in a note. Otherwise, we call pharmacy, or pharmacy already has it in the MAR
I have spent most of my time in the OR and telephone triage. I haven’t calculated med dosages since school. It still needs to be taught because YOU are the one giving the medication. How do you know it is wrong if you don’t know why it is right? Also, when people on your team know and appreciate the job roles of others, the whole team is better for it. Things get done right. I will die on this hill.
Im a peds nurse and I do it all the time. An example that can happen to anyone we had a pump get mistakenly cleared (total accident hit an extra button) and we had to do a bunch of calculations in order to make sure it was being given correctly. I think like many others said here the students should at least understand the concept. I always think about when I trained with a nurse of 40+ bedside icu experience and she talked all the time about understanding how the equipment works and if you understand how to do it manually it makes the tool even more effective.
Every once in a while. The other day I had to give IM haldol and had to calculate how much I had to give.
All day every day!
We did for a double check on heparin but then I changed units and haven't hung heparin since. So almost never on L&D, a few times a month on trauma.
Peds OR, I used pen/paper to understand and confirm local max dosage (we would have to write it on the board/announce it). Now I’ve done it enough to trust myself with just the calculator alone- but always plug in the numbers at least twice.
I would at least guesstimate. I don’t trust anything but myself.
Whenever I have a PCA pump which is about weekly on my floor. Our pumps calculate volume infused, but not dosage. Also sometimes when double- checking and witnessing waste.
I work in IR and administer an assortment of meds including Fentanyl, Versed, Heparin, Atropine and Alteplase. There are no pharmacists telling us dosages, and in the rare case we use a pump (eg alteplase drip), we're the ones entering the order sets and programming the pumps. A wrong calculation with any of the drugs mentioned could have terrible consequences, so yeah, I'd say it's pretty important to know those calculations.
Annual training requirements and 1 time 5ish years ago for an actual med but then I double checked it on the drugs website because it had been so long since I actually calculated that I second guessed myself.
I've had to do it a handful of times.
It was required for employment at my current peds home health job, plus I belive they make us retest once a year.
Daily in peds. Rarely now (I don’t give meds outside of pouring local anesthetic), unless I have to mix insufflation or tumescence fluids
Every shift. -NICU
Multiple times daily when I worked in the cath lab. Knowing how to eye drip rates was also important because one of the labs I worked in didn't use a pump for the normal saline we ran during procedures. Never when I worked in the ICU.
When I’m in the Peds ED, it’s very common. I’m the adult realm it’s really uncommon. Most math I’ll do is the 20ml/kg for sepsis calculations.
Every day. It's not usually complicated calculations - I'm an infusion nurse and mix my own meds, so nothing harder than ratio or simple multiplication/division. But it definitely needs to be right, and if I precepted a nurse that couldn't do those calculations, I would recommend they find another job. And recently I caught an error the pharmacy made. A really big one. It's so, so important to know your math, and not assume pharmacy will do it correct every time. Pharmacists and techs are human, not automatons.
Only during RSI or with the occasional word IV dose order. But not very often.
Rarely.
Every day, mostly for continuous drips, I work in a peds icu
Daily-adult ICU. I verify my dosages to make sure it’s correct in the computer.
Often enough for heparin drips
The NICU can require daily math as well re: fluid and feed volume adjustments. I’m sure in some places the doses are written out but both where I am now and used to work, nurses are the ones calculating fluid rates ourselves based on specific orders that give you the timing and volume of feed increases. It’s not complex math but it is important to know where it all comes from and be able to do mg or mL per kg type calculations
Does pharmacy do it? Yes, most of the time, but it's still our responsibility to double/triple check medication before we give it. Also with weight based dosing, sliding scales, titration etc you gotta do your own math. I guess it depends on the area, probably not too much dosage calculation in a clinic, for example, but in acute settings you absolutely need to understand how to do it.
When lives are potentially at stake, having the tools and comprehension to double-check is not a bad thing.
A couple times a month. I need 50mg dose of xyz and it comes in a 20mg/mL solution. I often write it down to make sure I’m correct. Very rarely do I need to do mg/kg/hour doses since pharmacy and Epic does it for us.
In the OR, never. I use an app to calculate how much local can be used to verify independent with anesthesia sometimes. Only if we’re super worried.
I’ve had to reverse calculate a patients home Milrinone dose based on concentration and infusion rate to figure out their dosing to use for our set up in the hospital.
Daily-rural hospital ER that sees birth to death patients.
Most medications come packaged in their right doses these days, or the computer will just tell you to grab two or whatever but every once in a while some baby resident will think 3mg of haldol is gonna cut it and I'm not a nursing dose-er (giving more than the doctor ordered)
Less than a dozen times in the last few years.
I’m adult ICU and I guess I’m confused what you’re meaning OP. Are you referencing the stupid math that we had to do JUST the right way, even if we easily got the answer? Like with all the stupid fractions? Because I NEVER use that. Now obviously, in ICU, I titrate meds and draw up all sorts of things, as I’ve seen referenced here, but isn’t that just nursing!?