Hello everyone,

We recently had an issue where a provider used our usual bronch order set to order prn fentanyl and midazolam:

- Fentanyl 25mcg iv Q3min PRN for moderate sedation (only as directed by physician)
- Midazolam 1mg iv q2min PRN for moderate sedation only as directed by physician)

This procedure was done on an ICU unit. Since this wasn't actually done in a designated periop area, it was a nurse who was administering the medications (not a provider), but these were documented in OpTime and not on the MAR under their respective orders.

Upon review, the doses documented in OpTime did not match the actual order as the provider asked for a few loading doses initially (fentanyl 50mcg and midazolam 3mg).

Our nursing teams are wondering if this would be a legal issue b/c the OpTime doses do not match the actual orders so there's nothing to "cover" the nurse if something goes wrong. In addition, OpTime documentation are just "one step" medications and don't have a dose/route/frequency tied to them like the MAR orders do.

What do other facilities do to address this? We want to make sure it doesn't look like our nurses are operating outside of the actual orders...

Any help would be greatly appreciated.

Thank you!