range order rationale

[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.

[MunoRN, RN]

There are responses in other threads that state you couldn't give the second norco for continued pain, but if you had an order for 1-2 percocet then you could give 2 percocet an hour after the norco. Is this pretty common?

[RescueNinja]

This thread has gone on way too long IMHO. The exact same questions (and some with a few words changed) have been asked and answered repeatedly over the last 8 pages.

[MunoRN, RN]

Maybe I'm being obtuse ... but I don't see much difference in administering the lowest dose of a range order, followed by subsequent administration of the remaining dose of the original order (which seems to be your preference) to achieve more effective relief ... vs. implementing multiple orders to achieve the same result.

The difference would be that in administering the minimum then remainder of a range order there is a set maximum dose, when using multiple orders there is no consistent max, except once you've maxed out your norco, percocet, oxycodone, morphine, dilaudid, and fentanyl doses (and probably narcan as well). Which would seem to be a pretty significant difference.

[MunoRN, RN]

This thread has gone on way too long IMHO. The exact same questions (and some with a few words changed) have been asked and answered repeatedly over the last 8 pages.

I've actually gotten 2 answers. My original question was what was the rationale for not up-titrating a range order based on continued pain. The only answer to that I got was that you would be giving an extra dose, although the math used to justify that didn't add up. Many said that range orders in general are no longer allowed by the JC, while this isn't really a rationale, it doesn't really matter since the JC does still allow range orders. I asked an additional question when it became apparent that many facilities no longer use range orders regarding the rationale behind more one-size-fits-all orders, and did get one answer to that which was that it's better because you can use multiple orders, although I'm not sure how that is really any different than range orders since you can still have a variety of options with range orders.

In the end, the fact that it took 8 pages to get 2 answers was really the most enlightening thing to be found, I now see why many facilities chose to abandon range orders given the daunting task of trying to establish a common understanding of the rationale behind them, at this point I wouldn't argue if facilities said you just have to call for each dose.

[hecallsmeDuchess]

I know that at my facility, we have an hour to give the second tab if a pt has a 1-2 tab every whatever hours for pain medication. If it's beyond one hour since the first tab was scanned, then they have to either wait the full time to get the next dose or the nurse has to get additional orders to give a NOW dose.

Personally, if I have a pt the first time I usually go through their MAR and see how their meds have been given by the previous nurse or if they are alert and oriented, I ask them how many works for them or I base it off their pain level. Other than that, I start low and go high.

[brownbook]

I just want to thank you for asking the question I wish I would have thought of asking.

I work outpatient, send patients home, and they pick up their prescription at their pharmacy on the way home. Their prescription is labeled 1 - 2 every 4 hours PRN. We often give patients one (or can be two) pain pills prior to discharge. I could NEVER think of a way to tell them when, if, how to take another pill if the one I gave them wasn't working after they got home and it hadn't been 4 hours!!!!

Your question, and some of the answers were a big help.

[CCL RN, RN]

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In the end, the fact that it took 8 pages to get 2 answers was really the most enlightening thing to be found, I now see why many facilities chose to abandon range orders given the daunting task of trying to establish a common understanding of the rationale behind them, at this point I wouldn't argue if facilities said you just have to call for each dose.

Thats actually a good point.

[shimono1]

Range orders are allowed and encouraged by the american society of pain management nurses. They are NOT practicing medicine. some JC auditors mistakenly cite range orders as red flags, when JC itself allows for them. Please see http://www.aspmn.org/documents/RangeOrderPublished2014.pdf