Meds: PRN or scheduled administration - page 2

Lately, in that ever-elusive quest for the perfect patient satisfaction scores, our NM has decreed that all pain meds are to be offered at exactly the time the patient could have them. That is to... Read More

  1. Visit  NurseKatie08} profile page
    1
    working 2nd shift, i often run into the issue of people sleeping, prn pain meds, etc.
    where i work short term rehab, my pts are there for a while and i get to know them.
    i always ask, or am told in report what they got for pain during 1st shift...when i make my first rounds & do 4pm meds, i make it a point to assess pain, medicate as needed.
    furthermore, i make it a point to assess pain again during my 8pm med pass, and offer prn meds as appropriate. i find that many of my patients are scared to ask for pain meds, for some of the reasons others have mentioned.
    many of my pts go to sleep early, but where i have them awake for 8pm med pass, i always make sure they are appropriately medicated at that time, if they so request. i've yet to have a 3rd shifter tell me that any of my patients have woken in pain saying "that evening nurse never gave me any pain meds", so this system seems to work for me, and the pts.
    SuesquatchRN likes this.
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  3. Visit  leslie :-D} profile page
    5
    Quote from Pediatric4077
    Waking them? Who needs a pain pill if they can sleep through the pain? That doesn't make sense to me. Prn is as needed. End of story, not offered every time they can get it.
    that's one of the biggest myths out there...
    that people cannot sleep when in pain.
    actually, pain is exhausting.
    granted, folks in pain aren't getting quality sleep, but it can zonk you nevertheless.
    ever look at the face of a sleeping person in pain?
    their faces are not relaxed and they are never in a deep sleep.

    if pts are getting a basal dosing of a long-acting med, then prn's for breakthrough, can and should be given as needed.
    but if the prn's are the only means of pain relief, then ideally, the order s/b rewritten to scheduled.

    whatever the means, if a pt is in pain, it is critical that we stay ahead of it.
    that is basic pain mgmt 101.

    leslie
  4. Visit  SuesquatchRN} profile page
    2
    Quote from core0
    To tell a nurse to give a PRN as scheduled completely negates any element of professional nursing.
    Offer, not give.
    Jules A and SharonH, RN like this.
  5. Visit  tntrn} profile page
    2
    Quote from Jules A
    I understood it differently in that the meds were to be offered not automatically brought or forced on the patients. OP?
    That was what she came up with several months ago. NOW, we are to treat pain meds for Post-Op patients, as if they are scheduled. We are to tell them we WILL be waking them up to take their pain meds.

    I think those who are too shy to ask, might also be too shy to tell us to take a hike, or that they don't need or want a pain pill right now, or that they'd benefit more from unterrupted sleep than a pain pill that isn't needed at this time.

    Our NM does have bedside experience, but has really gotten on the managerial bandwagon, I think. It's truly all about the patient satisfaction scores. But I think this could backfire.
    Jules A and SuesquatchRN like this.
  6. Visit  tntrn} profile page
    1
    Quote from SuesquatchRN
    I think that what your NM has noticed is that some nurses give PRN's, some don't. I've worked with people who wouldn't give a stinking Benadryl because she "doesn't like drugs." Erm, okay.

    She's trying to insure that nurse prejudice doesn't affect patient care.

    Waking them if they're sleeping, though - nah.
    I wish that were the problem. That's not it at all. And if it were, why not cousel those nurses who aren't giving prns, if it can be proven they are withholding meds from patients, instead of making all of us, including the patients, suffer?
    medsurgrnco likes this.
  7. Visit  SharonH, RN} profile page
    3
    Quote from NurseKatie08
    i've yet to have a 3rd shifter tell me that any of my patients have woken in pain saying "that evening nurse never gave me any pain meds", so this system seems to work for me, and the pts.

    lol, give it some time. It will happen; they don't mean to be malicious sometimes they honestly forget.

    Earlier Leslie spoke of patients waking up in pain. In my first response, I said that it was nuts to wake a patient for pain meds but Leslie was right, I have had folks wake up crying in pain. It's a pretty individual thing; some patients will ask you to wake them up for pain meds and some will complain bitterly about not being allowed to sleep. Unfortunately, if you are unfamiliar with the patient you don't know who wants to be awakened and who would mind a lot if you woke them up. There's no way to beat that; it is merely a matter of trial and error.
  8. Visit  SharonH, RN} profile page
    1
    Quote from tntrn
    That was what she came up with several months ago. NOW, we are to treat pain meds for Post-Op patients, as if they are scheduled. We are to tell them we WILL be waking them up to take their pain meds.

    I think those who are too shy to ask, might also be too shy to tell us to take a hike, or that they don't need or want a pain pill right now, or that they'd benefit more from unterrupted sleep than a pain pill that isn't needed at this time.

    Our NM does have bedside experience, but has really gotten on the managerial bandwagon, I think. It's truly all about the patient satisfaction scores. But I think this could backfire.

    Actually, if a pain med is prn you cannot give it as scheduled unless ordered. Period. You have the law on your side. As for telling patients they will be awakened and them being too shy to refuse, ASK them if it is okay to awake them. Give them a choice, even the wimpiest patient will take the choice that suits them. Your nurse manager cannot do anything about that. And if patient satisfaction scores are all she is worried about, then trust me they will complain just as much about not being allowed to sleep as about being in pain so her policy is doomed to fail anyway.
    SuesquatchRN likes this.
  9. Visit  medsurgrnco} profile page
    2
    If the MD wants a med to be a scheduled med, then the med order is written that way. A PRN med is as needed and is not to be given routinely.

    I ask pts about their pain level & needs when I do their assessments. I let them know what pain meds are ordered and how often they can have them. I also ask about pain needs whenever I see pts throughout the shift. By talking to the pts and looking at the pain meds given on the prior shift, I know which pts are likely to want pain meds as soon as they can have them and which pts want to be woken up to be given pain meds and so check in with them at those times to OFFER pain meds.

    I am so sick of managers telling me what to do instead of trusting my nursing judgment! I don't have time to keep track of when every single pt can have PRN meds and run around to all those pts to offer them, with all the other tasks I am expected to do during a shift.
    Melinurse and tntrn like this.
  10. Visit  Virgo_RN} profile page
    5
    Part of the nurse's job is to be educated in pain management and to teach patients and their family members about pain management. I think confusion comes into play when nurses themselves don't have a strong grasp of the concept or fail at educating the patient/family.

    Case in point. We had a day 2 postop patient transfer to our cardiac floor in a rapid A-Fib, diltiazem gtt ordered. My first order of business was getting her tucked in, placed on tele, getting vitals, and starting that drip. During my initial assessment, I asked her about her pain, knowing that she was day 2 postop, and she told me her pain was well controlled.

    The first order of business for the family was to pull me aside, first the husband, then later the son, then when I was in the room assessing the patient, the whole family confronted me, about the patient's pain management. They were in utter disbelief that the nurses on the other floor, where she had gone postop, had told her that she had to ASK for pain medications. They said because of this, she hadn't had anything for pain for twelve hours. Aren't pain medications scheduled for every four hours? Why in the world would she have to ask to be medicated? They said the nurse on the other floor had told her that if her pain was not controlled, she wouldn't get enough oxygen. Well, when she went into the rapid A-Fib, she was short of breath. Doesn't that mean that her symptoms were caused by not getting enough pain meds? I had to explain to them what rapid A-Fib is and how it affects the body, and why a person would feel SOB and chest pain when their heart is beating that quickly.

    Obviously there was a huge knowledge deficit here and a need for some teaching. I could not speak to what had happened on the other floor, because I had not had the time to dig through her charting to see what pain meds had been ordered and what she had recieved, since I was more concerned about her rapid A-Fib at the moment. Plus, I think the family was really looking to place blame on the nurses on the other floor, and I was not about to jump on board with that.

    I think policies like the one your NM is trying to enact will do nothing but fuel the ignorance and take control over nursing practice away from the individual nurse. If a nurse is being too stingy with pain meds or is not teaching their patients about pain management and working together with the patient, then that nurse needs to be addressed individually. If it is a widespread problem, then a mandatory inservice on pain management would be more appropriate than changing policy, IMO. Another factor to look at is staffing. If nurses are too overworked to be able to be effective in the area of pain management, then staffing levels need to be looked at.

    When it comes to patient satisfaction, having a nurse that has the time to address the needs of their patients would be number one on my list. Not these silly little policies that only serve to draw attention away from where the real problem lies.

    ETA: I wouldn't do it. I would continue to manage pain the way I do, because I know that I am effective at it. If all of the nurses on the unit stick together and do not comply, they cannot fire all of you. They will see the policy is not working, and it will fall by the wayside.
    Altra, Melinurse, nursej22, and 2 others like this.
  11. Visit  mykrosphere} profile page
    0
    Quote from earle58
    that's one of the biggest myths out there...
    that people cannot sleep when in pain.
    actually, pain is exhausting.
    granted, folks in pain aren't getting quality sleep, but it can zonk you nevertheless.
    ever look at the face of a sleeping person in pain?
    their faces are not relaxed and they are never in a deep sleep.

    leslie


    that is absolutely true.
    (unfortunately)

    pain control is a huge issue with me after working a short time in hospice.
    i think a lot of nurses arent more proactive in this.
    some think the patient is just "drug seeking" because they dont display any pain, but just because the patient is stoic, does not mean theyre not having pain.
    people certainly do react differently to pain.
    it all comes down to knowing the patient i guess.
  12. Visit  core0} profile page
    2
    Quote from SharonH, RN
    David, excuse me but how does putting them on scheduled pain meds address their reluctance to take pain meds? If they don't want to take them, then the proper thing to do is to assess the reason for this reluctance and then educate.
    There are some patients that the nurses are unable to overcome either personal or cultural reluctance to ask for nurses. Sometimes it can be communication issues but a lot of times its a reluctance to bother the nurses. Also if you see a patient asking for a med consistently you can either put them on a long acting (mostly what I do) or if you think they are going down on their pain meds then schedule it for a few days then put them on PRN. If I schedule I usually put a breakthrough PRN order with a longer interval.

    David Carpenter, PA-C
    Virgo_RN and Altra like this.


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