[kasi]

A nurse I work with asked me about the following order:

Vicodin 5/500mg 1 to 2 tabs every 4hrs PRN

Her question was, if she gave the patient one Vicodin tab at 9:00am and the patient was complaining of pain at 11:00, then could she give the other Vicodin tab at 11:00. (no MD order to give the extra tab before 4 hrs). She says this is common practice at the hospital with PRN meds. Then they will medicate the patient with 2 Vicodin at 1300, because the first Vicodin was given at 9:00am

Another example is Ativan: 0.5mg 1 to 2 tabs every 4 hrs PRN.

Again, I have seen nurses initially give the one 0.5mg, but then an hour or two later, they give another 0.5mg of Ativan. Their rationale is that they only gave one tab and the MD ordered up to 2 tabs.

I tried to explain that you can only give as ordered ( every 4 hours), and if the patient requires more in less than 4 hrs, then they need to get an MD order to give the additional dose.

[natsfanrn]

We had a debate about this where I work. I have no problem giving one Vicodin 2 hours later if the patient rec'd one and the order was for 1-2 Q4...sometimes the one just didn't help and others just seem to have their pain controlled better if they rec'd one Q2 instead of two Q4. Others said I couldn't do this. Finally called pharmacy and they said there was no problem giving one every two, as long as the patient didn't receive more than 2 in a 4-hour period. I've never had an MD object to this practice, either.

On a related note, I had a patient complain that her nurse wouldn't give her half of a Percocet when she didn't want to take a whole one, saying that she couldn't because the order was written as one to two tabs

[lmessajumper]

I am a stickler for pain management in my patients. I try to always remember that they are my priority. The important issue in the above situations is that the patient's pain/anxiety is not being resolved. I assess the patient and medicate accordingly. To me, if you don't feel comfortable giving a pain med an hour early, call the MD and get an OK-but please don't just let the patient suffer because "it's too soon" or "the doctor didn't order it like that". Do what you have to, but get that patient some relief!!!

[NurseyPoo]

Originally Posted by lmessajumper

I am a stickler for pain management in my patients. I try to always remember that they are my priority. The important issue in the above situations is that the patient's pain/anxiety is not being resolved. I assess the patient and medicate accordingly. To me, if you don't feel comfortable giving a pain med an hour early, call the MD and get an OK-but please don't just let the patient suffer because "it's too soon" or "the doctor didn't order it like that". Do what you have to, but get that patient some relief!!!

Excellent advice! There is nothing worse than being in that kind of pain and not being able to have anything...Been a patient myself and when I needed to have pain medication my nurse messed up and gave me too small a dose. She gave me 1 tab instead of 2...She also would not cover me until the 4 hours was up. I tried to tell her I wanted 2 tabs and she stated she had to wait. It was awful, and she knew I was a nurse! She terated me like I was being dramatic...I was not being dramatic.

I use my nursing judgement and if a patient is not getting relief I call the Doctor as soon as I realize this. 95% of them will give an order for a stronger dose or something to cover break through!

[jamminworld]

I base how much medication I give to my pt based on their diagnosis and reaction. With a new order I usually start with the minimum dose and give it time to take affect. If it hasnt worked then Ill give the additional ordered. If still not relieved I have no problem calling the Drs for more medication or an alternative medication. After I establish how much it takes to relive pain in that pt I give that dose from then on out and pass it along to the next nurse. I have no problem splitting the medication in two smaller doses if needed and the Drs. where I work have never said anything as long as we arent giving more than the limit.