Rule Book On Narcotic Pain Medication

I see you have three posts so far on this same subject so it is very difficult to follow this along as a thread with three separate posts to look at but anyway.......I do believe that q 4 hours prn on a narcotic pain med means just that.......every 4 hours---not every 3 1/2 hours because patient requested....if thats the case we'd have patients requesting every 3.5 hours and in the course of 24 hours you'd end up giving an extra dose. I guess it would all depend on what your hospital's policy is however I would not give it any sooner than every 4 hours if thats the way it is ordered.
The difference between scheduled meds that are ordered every 4 or 6 or 8 hours are they are scheduled and if they are given 30 minutes early or late the patient will still not receive a extra dose in the 24 hour period.

If it's ordered like q6hr, I might give something a few minutes early,
but for q4hr I usually try to stick closer to the 4 hours. If they're not getting any relief on their ordered schedule, then the doctor needs to be called.
But a nurse has to be careful. You wouldn't want to give something 15-30 minutes late and the next nurse give it 30 minutes early. That's getting too close. Right? Patients can be tricky, some of them. I give narcotic pain med to a patient now, and she will do everything she can to get me to give it early. One night she swore to me that she had not had her last pain pill. It was signed out, documented on the MAR, but she sure tried every trick to try to make me believe she didn't get it.
Of Course, I didn't give until scheduled time several hours later. I knew she had rec'd her pain pill. She just didn't remember, or didn't want to remember.

I'm rambling, back to your original question.

I stick to the 4 hour rule as well and if they are showing a pattern of continually asking for it before the four hours is up then they need either A) a breakthrough dose of the same drug or B) a different drug . A call to the doc of course for someone not responding well to narcotics.

I'm going to swim against the tide but I have always understood it was permissible to give a pain medication up to thirty minutes before it was due, if one had determined it was necessary. To avoid any conflict, I would ask doctors to write the medication for every three of four hours. Rarely did a patient ask for it three and half hours before it was due. This focusing on waiting exactly four hours, is in my opinion, silly. We will not make a patient and addict by giving him/her their medication a half an hour early. In fact, it is really better management of their pain and it doesn't increase their pain level and agitation, like strictly adhering to 'every four hours only, to the minute'.

Woody

Our POLICY is that we have a 30 minute window with narcotics to give early or held late. If a patient needs it before that I simply call the doc. I've honestly never said it's not time yet, you'll have to wait.

Now I've called and said the patients objective signs do not reflect the amount of pain they are reporting and said the opposite when true, so the doc has the knowledge to choose the right med and dose. I usually call for a one dose break through, unless I am sure I need to increase the frequency then I ask for a break through PRN.

We have orders that vary from Q1 hr to Q6 hr, so I don't have any hourly rule that I go by and I've seen such a varying need for pain meds over the years that I don't impose an arbiturary time frame.

hope this helps

Zookeeper---I understand what you are saying and I agree with the fact that if they are needing the med more often than every 4 hours it is time for the MD to be made aware of the level of pain with no relief. I wasnt implying in my post that I'd ignore the c/o pain but the point I was getting at was 4 hours for a prn is just that....4 hours and not 3 and 1/2 hours...at least that is our policy and I suppose every hospital is different but the point I was trying to make is we all know of the patients that are constantly in need of a narcotic pain med so therefore they'd be requesting every 3.5 hours so in the course of 24 hours if the drug was given every 4 hours you'd have given 6 doses however if given every 3.5 hours then 7 doses could be given...I understand that pain is an objective symptom and I dont want to make this a post about pain relief all I wanted to do was point out that by giving the dose 30 minutes early it could potentially lead to extra medications that were not really ordered.

umn, sorry, did not mean to offend or get preachy, I initially didn't look at you're experience level and wanted to be thorough in case this was a new outlook for you. does that make sense?

sorry, but your second post was much clearer to me, Coming from a cardiac unit as well. Lets say the dose was Q6 hrs, (on the 6-12 schedule) if I give it 30 minutes prior per policy for the 6pm dose 17:30 then I cannot give it until 23:30 which does not add the dose over 24, just gives me the 30 minute window for each dose. This keeps the order from the MD as ordered.

again, I'm sorry, should have read your experience. I've just tried to be thorough in my responses so they're not read wrong, I guess it came out wrong anyway

We use a MAK computerized system that will prevent us from administering even a minute before that 30 minute window, perhaps you or someone can head up a policy change to address your concern because if I read you right, your patients can and are getting an extra dose that is not covered by the order.

Because I can't give the extra dose, I read your post in a totally different light, head is fully under the chair, thanks for the understading

I could be way out of the ball park here, but I am betting that most of us have given a narcotic early at some point. I agree with the post that the half hour rule covers regular schduled meds only. If you asked a pharmacist, I think they would make you wait til the last second!..lol I wonder why a facility would fire you over one incident. Ususally a reprimand or reminder unless policy was continuously broken. You might benifit from some legal advice if you do not have a union. Good luck!