Rule Book On Narcotic Pain Medication

Ok Zookeeper.....I understand still what you are saying and I agree that if its a regularly scheduled med for instance q 6 hours then our policy is actually a hour either way and I realize that no extra dose would be given in that instance because it is a regular dose...but lets look at PRN meds....lets say it is q 4 hours and its given at 6am...then each dose thereafter is given every 3 1/2 hours.....it would be 930 instead of 10....then 1 pm instead of 2 then 430 instead of 6...so there in less than 12 hours you are off by 1.5 hours.....follow that thought thru for a whole 24 hours and you'll see where the extra dose comes from. I know my logic seems like a very little error and I will be the first one to admit that if the OP was fired and reported to the board of nursing that I find that totally crazy because looking at the big picture it is a very little problem however I was just attempting to point out what the hospital will probably say in order to justify why they fired the OP.......and btw.......I did not find your post offensive at all and was just attempting to explain my thoughts better.

Let me clarify---- I am not saying I agree with the OP being fired....I am not saying that I agree with the strict rule for prn meds or that I have never given a med prn or otherwise early......if we're honest we'll admit we do things that arent always "by the book".....what I am doing is trying to point out where the hospital will attempt to come from in this instance and I could easily see where they could say medication was dispensed without a MD order for the mere fact that a extra dose could be given over a 24 hour period....does it happen often?? I would say not but you know the reality of nursing and the way we do things compared to the actual rules that the hospital or BON could imply if they wanted to are entirely different.
I think we all do what is best for our patients but if we're honest with each other and ourselves we'd all admit that in some situations things could be done by us one way but viewed by others differently.
All I am saying is that if you look at things from a legal issue the potential is there for someone to say that the judgement made was outside the scope of nursing because it involved a medication which needs to be ordered by the MD and followed per instructions...do I agree or am I critizing the OP....NO I am not...just pointing out the way things are compared to the way they are done.

I have to agree with Kymmi the reason I would not give a q4 med early is because is this was done all day long they would get an extra dose by the end of the day. As well if the pt was in pain again in 3 1/2 hours I would call the MD and ask for the order to be changed or get coverage for break through pain. Now if its a scheduled narc we have a one hour window each way to give this. There is saftey in this because there is no risk at them getting an extra dose. Just lowsy coverage if people arent careful and try to time the doses out right. Neither way is perfect or 100 percent fail proof for pain coverage. Having said that I am surprised you were fired and reported for that. If the pt was stable when you gave I wonder why they went so far. You were obviously looking out for your pt best interest, being pain free. Did you also follow through after and try to get the orders changed? I would investigate this furter and as others say alert your malpractice insurance about the situation. Always be overly protective when someone is going after your license, no one is your friend in that situation but yourself and your insurance.

at our facility, there is no window for prn's, and a 30 minute window for scheduled.
i was taught in school there is never a window for prn's.
but of course, that was in the mid 90's, and regs are always changing.

leslie

Personally, I'm not too anal here. The ideal is following the orders, however the policy of your facility will give usually 30 minutes before and after the time ordered as we cannot be in 5 different places at the same time. Sometimes five different patients have meds ordered at the same time. If, after the appropriate pain assessment, I will let the MD know what the assessment shows, how often patient is making requests for the pain meds, etc. and make a recommendation.
The whole idea behind the policy of 30 minutes before and after is because we cannot be a half dozen places at the same time, and surprisingly, this is one thing that administration actually acknowledges with the policy.

I understand the 30 minute window and not being able to give all meds that are ordered for say 10 am at exactly 10 am....that is not what is being questioned......its giving a prn med 30 minutes early that is in question so in other words if your patient is requesting a prn med that isnt due for another 30 minutes then it shouldnt be given until the 4 hours is up for the reason I've listed above.

Hi; I'd say q 4 hours is q 4 hrs. If the patient needs more talk to the doctor and get a plan for the patients break through pain. Although, a few times in my 30 year career I have given narcotics early. Rules always get broken. good luck WhiteFlowerRN

If I give a PRN narcotic at 3:10, I chart 3:10. I used to chart 3:00, but due to the same reasons posted on this board I don't. I have had nurses use the 30 minute rule , but peer pressure gets them conforming. If you give a narcotic early you should have a full set of v/s, documented supervisor approval, and report it to oncoming HCP. I work nights, this would mean suggest to the doctor a stronger pain med, his pain is poorly releived at night,etc.

I have a question for those of you who call the doctor when the patient ask for his pain medication a half an hour before it is due. You call the physician and in my experience, it generally takes up to a half an hour to get the doctor on the phone, explain the situation and get the new order. In the mean time, the patient is laying in bed, in pain, waiting for a shot that will be given at the exact time of four hours. Why can't you give the pain medication at three and half hours, call the doctor and get the medication order changed to every 3 to 4 hours, prn?

Woody

Woody....that is actually exactly what I would do.....I do not see a problem giving it a few minutes early one time as long as you are going to address the issue and get the order changed to be valid. The point I am trying to make is not to keep giving it 30 minutes early without getting the order changed....thats where I could see trouble coming because the issue wasnt addressed and a extra dose ended up being given.