Rule Book On Narcotic Pain Medication

I've given 5 or 10 minutes early a few times, that's it. I will then call the doctor and tell them that the pain meds aren't holding. The doctor needs to be aware.

How do you guys handle, say a patient is allowed 1 or 2 percocet. They want to try 1, but then an hour later they want the second one. Do you split the difference on the next dose? For instance, at 0800 they got the first one, then at 0900 they get the second half of their full dose. They can have it every 4 hours, how soon will you give the next dose?

I would give 2 Percocets at 1:00. 4 hours after the second dose.

Nope, our policy allows us the 30 minute window for the PRN's, ONCE it is given, than you re-time it from there.

The only way this ficticous "extra" dose occurs is if the doctor wrote, Q6hrs, max 4 doses and it cycled around enough to make 5, well thats a clear med error. Can only give 4, not 5 doses. The physicians are well aware of the 30 minute window. It's not an extra dose, its administering meds according to policy. If there is no max dose written in 24 hrs. you are placing your own restraints on a max dose that doesn't exist and giving yourself too much worry.

I don't recall you stating what your policy said. What MINE states is irrelevant.

If your facility does not grant you this in writing, then your PRN's can only be given up to the minute.

Now I would give it at 1230, splitting the difference between the two percocets from the morning dose.

In most facilities now when doing an assessment,pain is documented along with interventions and outcomes. JACHO has established a record of the importance of pain assessment,relief,interventions and documentation. There have actually been lawsuits,pt's families against doc's, for pt's being left in pain without relief. As nurses we have no right to with hold meds from pt if ordered. If a pt is having break throu pain, a doc needs to be notified and new orders obtained. It all should be well documented. If pain is a constant issue, most facilities have a "pain team"from the pharmacy that can be consulted, sometimes just by nursing. I have given pain med early when I know a person is having trouble and feel comfortable they can handle it. I then call the doc, let them know that I gave it early,why, and ask for a new order . Most MD's will respect the RN's decision and even cover you with a one time stat. Team rounding and planning can also be an asset in these cases in planning a pt's care. Pain is a really big area being watched these days by accrediation and reimbursement companies. Much feedback by pt's and their families concern the lack of pain control. We always need to cover ourselves and follow facility policies,and most of all be a good pt advocate!

I realize it goes by hospital policy however if you follow my therory you will see why I think that giving a PRN med early will result in a extra dose. If a drug is ordered q 4 hours prn then the most the person will receive in a 24 hour period is 6 doses however if it is given q 3.5 hours then they will receive 7 doses. I know it seems like splitting hairs however fact is fact....a extra dose has been given. If you are trying to use the 30 minutes rule on REGULAR scheduled doses that is different because they are ordered at set scheduled times so if it is given 30 minutes early or late it wont matter because the regular schedule will just pick up next dose.
I am not saying withhold the med and make a patient suffer....I am saying I'd give it early ONCE and then let the MD know that something else needs ordered.

And I doubt neither one of us are doing something a prudent nurse would consider in error.