range order rationale - page 5

So you've got an order for 1-2 Norco q 4hrs prn pain, you give 1 at 1200 for 6/10 pain. At 1330 their pain is still 4/10, does you interpretation of the order allow you to give the second or do you have to wait until 1600? How... Read More

  1. 2
    The order says 1 to 2 (1-2) not 1 OR 2. I would give a second, but I would wait a full 4 hrs after the 2nd pill before giving another.

    If my pt needed more during that period I'd call the doc because there is a reason this pt is having pain that is not controlled with narcotics and the doc should know as it may need to be investigated.
    nuangel1 and miss81 like this.

    Get the hottest topics every week!

    Subscribe to our free Nursing Insights newsletter.

  2. 1
    Great thread, no one got nasty, will agree to disagee. But love a lively debate! Peace!
    glutton4punishment likes this.
  3. 0
    Aside from how facilities may have come to decide to do-away with range orders, do those of you not using range orders find that you are able to provide better care as a result of not having range ordrers?
  4. 1
    Quote from CCL RN
    Range orders are not allowed at my facility. It would be more like:
    1tab q4 PRN for pain 1-6
    2 tabs q4 PRN for pain 7-10.

    So I'd give one tab and wait 4 hrs to give the other.
    In LTC we are not permitted range orders either and clarify the orders to be like the above. I would see if they had any other orders for tylenol, motrin or ultram and see if one of them can be given. at the next dose, I would give the two tabs or if it was really severe, I would call the doc to see if it could be given early and change the orders.
    Even tho I stated that I was in LTC, we are more of a rehab and get alot of hips, knees and other post ops around day two or three and have a good bit of pain issues to deal with.
    CCL RN likes this.
  5. 0
    Quote from michelle126
    In LTC we are not permitted range orders either and clarify the orders to be like the above. I would see if they had any other orders for tylenol, motrin or ultram and see if one of them can be given. at the next dose, I would give the two tabs or if it was really severe, I would call the doc to see if it could be given early and change the orders.
    Even tho I stated that I was in LTC, we are more of a rehab and get alot of hips, knees and other post ops around day two or three and have a good bit of pain issues to deal with.
    So if you discovered that 1 tab was not sufficient for 6/10 pain you could give 2 the next time? Or would you have to call the Doc only to supplement the current dose? Would you educate the patient the they were wrong, their 6/10 pain was obviously 7/10 since 1 norco wasn't sufficient and we all know that 1 norco is sufficient for everyone's 6/10 pain?
  6. 1
    Quote from MunoRN
    So you've got an order for 1-2 Norco q 4hrs prn pain, you give 1 at 1200 for 6/10 pain. At 1330 their pain is still 4/10, does you interpretation of the order allow you to give the second or do you have to wait until 1600? How would you interpret this and more specifically why?

    I know there have been other threads on the subject of range orders but what I haven't been able to find is rationale for different views that exist on these threads. I'm having a hard time understanding why so many nurses believe a medication ordered as a range order can only be administered once during the timeframe rather than titrated to effect, please enlighten me.
    Don't worry, range orders are becoming a thing of the past. JCAHO is cracking down on them. My hospital has completely eliminated them.
    CCL RN likes this.
  7. 0
    Quote from Chin up
    It's is not about the 1-2 or 1 or 2. It is about once the dose is given at 12, the order was fulfilled. An hour and a half later does not make up for the one not given at 12. It starts a new order. By calling for a stat order, you are able to give one at 1:30 and STILL give 1 or 2 at 4:00 and not have to wait till 5:30.
    So how do you determine to give 1 or 2? If you guess wrong why should the patient have to suffer? How would you prefer that the order be written so that it would allow you to give the 2nd while still assessing for the effectiveness of 1 tab first? What's the rationale in terms of better patient care?
    Last edit by MunoRN on Apr 4, '11
  8. 0
    Quote from McGyverRN
    Don't worry, range orders are becoming a thing of the past. JCAHO is cracking down on them. My hospital has completely eliminated them.
    JC isn't "cracking down" them in terms no longer allowing their use. All they have done is to push for consistent implementation of them. There are plenty of sources explaining this if you read back through the thread.

    I'm beginning to wonder if their is any basis to really anything Nurses believe to be true.
  9. 2
    Quote from MunoRN
    JC isn't "cracking down" them in terms no longer allowing their use. All they have done is to push for consistent implementation of them. There are plenty of sources explaining this if you read back through the thread.

    I'm beginning to wonder if their is any basis to really anything Nurses believe to be true.
    JCAHO just surveyed my hospital and they absolutely demanded that we eliminate range order dosing. Perhaps the surveyors who came to your facility did not, but ours did. So yes, I do have a basis for what I believe.....experience.
    CCL RN and Chin up like this.
  10. 0
    Quote from McGyverRN
    JCAHO just surveyed my hospital and they absolutely demanded that we eliminate range order dosing. Perhaps the surveyors who came to your facility did not, but ours did. So yes, I do have a basis for what I believe.....experience.
    Hospitals often get rid of range orders and claim they had no choice from the Joint Commission, although the Joint Commission has been clear that range orders are still an option if used consistently, even if a hospital fails to meet the recommendations of the JC, the JC is not a regulatory agency so the JC doesn't have the power to ban range orders even if they set out to do so. The JC would insist that a facility avoid range orders if the facility refuses or is unsuccessful in establishing an adequate policy or educating staff on it's use, but the JC does not prohibit the use of range orders as an absolute.

    As an example, if a nurse is found to be diverting narcotics the BON may state that RN can no longer administer narcotics, but that doesn't mean the BON no longer allows nurses in general to administer narcotics, just those that can't meet the requirements for doing so.

    The accreditation binder is pretty clear on this (mm.3.20), as are the numerous articles that discuss the issue, such as this one:
    http://www.medscape.com/viewarticle/480067_2
    and this one:
    http://forums.pharmacyonesource.com/...-Them/ba-p/382

    Hospitals often find it easier to do away with range orders thinking that you can achieve the same level of care without them, although as the American Pain Society and the Society of Pain Management Nursing both point out this is not the case:
    http://www.aspmn.org/pdfs/As%20Neede...e%20Orders.pdf
    Based on this I'm surprised how easily Nursing seems to have allowed administrators to do away with an evidence based best practice for the purpose of avoiding the hassle of updating a policy or clarifying it's use in order to make a JC visit easier.
    Last edit by MunoRN on Apr 4, '11


Nursing Jobs in every specialty and state. Visit today and Create Job Alerts, Manage Your Resume, and Apply for Jobs.

A Big Thank You To Our Sponsors
Top