Saturday, May 26, 2012

Tales from Residency:Tigan

My attending offered my patient with nausea a medication called Tigan, which I've never used before. I didn't know why he chose it, except to make my life harder.

Friday morning: Patient says she wants Tigan, but she'd prefer a suppository because she doesn't like to swallow pills. I write the order for Tigan 300mg PR. (PR = per rectum)

Saturday morning: Patient says she's now reconsidered and doesn't want pills pushed up her ass. She says she wants the Tigan orally. I discontinue my old order and write for Tigan 300mg PO. (PO = oral)

Saturday afternoon: I get paged and told that Tigan only comes as 200mg pills and I have to rewrite it.

Sunday morning: I get paged and told that the patient now wants the Tigan as a suppository. So I give a verbal order to give the 200mg of Tigan either PO or PR.

Later that morning: I get paged and told that the Tigan suppositories only come as 300mg tablets, so I give another verbal order.

When I finally arrived on the patient's floor on Sunday, I was approached by like three nurses who said that I need to clarify the Tigan order. I flipped to the orders in the chart and see like three pages of orders for Tigan. I said, "This is ridiculous! I've written for this like six times!"

Sometimes I feel like there must be a better way.


  1. Your patience with your patients is admirable.

  2. There **is** a better way: Tigan 300mg PR or 200mg PO (after checking to see what the available dosage forms are). Totally makes sense for a patient with nausea.

  3. The easiest way is to write two orders, each with an instruction to give only one or the other. Docs here do that all the time for things like Tylenol (PO or PR) and pain meds (PO or IV).

  4. The pharmacist was probably thinking, "Damnit, this is the 6th time I've called on this order. How hard is to write Tigan 300mg PR or Tigan 200mg PO for God's sake." :-)

  5. So true, Amanda!

  6. Just out of curiosity, does this patient not have IV access? Or is this a med that the pt. may need to take at home, so it's being trialed in the hospital to see if it works for her? (I rarely see non IV anti nausea meds used in my hospital.)