I am nurse at a hospital with many patients recovering from recent surgeries. Most orders related to pain meds go like this: Order #1--Pain med 5mg PO PRN Q4H for c/o mild pain, 1-5 Order #2--Pain med 10mg PO PRN Q6H for c/o moderate pain 6-10. Is it ok to give 10mg for c/o pain rated 9, then if pt asks 3 hrs later for 5mg for c/o pain rated 5, give 5mg? My charge nurse says no, its one or the other until the time is up, so if pt takes 10mg, they have to wait 6hrs before anything else can be given. I was taught they are different orders so it was allowed--granted pt isnt snowed & VS WNL.

If #1 and #2 are the same medication, I would wait 6 hours before giving more (after administering the maximum dose of 10mg). The exception would be an order for the same medication for "breakthrough pain" or an order for a different medication altogether.

I was also taught that if the orders are separate and there's nothing in the notes section that specifically prohibits the administration of the other drug concurrently, there's nothing to keep you from giving Drug A on schedule with Drug B. Especially if the drugs are different classes of meds...for instance, Drug A is Tylenol and Drug B is Morphine.

However, I could see issues arising if Drug A was Tylenol and Drug B was Percocet--then you'd have to be worried about how much acetaminophen your patient is getting. Or if you had two drugs that were both opioids--Drug A is Morphine and Drug B is Dilaudid--and you were worried about overdose.

My thoughts were along these lines too. I've staggered Percocet and oxycodone a lot, since opioids' upper limit depends on the pt's tolerance, or PO and an IV med where the PO med is for moderate pain, IV for severe pain. Something like acetaminophen you have to be careful with, so if they had ES Tylenol then they'd have to wait for Percocet (Years ago I followed an RN who did give tylenol for breakthrough after taking Vicodin...). However, if their pain was uncontrolled I'd be calling the provider for another or a new order.

I am nurse at a hospital with many patients recovering from recent surgeries. Most orders related to pain meds go like this: Order #1--Pain med 5mg PO PRN Q4H for c/o mild pain, 1-5 Order #2--Pain med 10mg PO PRN Q6H for c/o moderate pain 6-10. Is it ok to give 10mg for c/o pain rated 9, then if pt asks 3 hrs later for 5mg for c/o pain rated 5, give 5mg? My charge nurse says no, its one or the other until the time is up, so if pt takes 10mg, they have to wait 6hrs before anything else can be given. I was taught they are different orders so it was allowed--granted pt isnt snowed & VS WNL.

Depends on what the drugs are.