Meds: PRN or scheduled administration - Page 3

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.

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.

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.

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