PRN Narcotics?

[Finallydidit]

Okay... We all know in LTC we have a window of 1 hour before to one hour after to give a sched medication even if it is a narc. ie. sched at 5p can give it anytime between 4 and 6p.

My question is what about PRN narcs. Say they are ordered Q6/hr, can you give them Q5? Is there a window for admin it early?

My thought on this is NO there is no window for giving it early, unless you call and get an order.

Whats your view/policy?

Thanks

[skyandsydneysmom]

If you are in LTC and you have a patient with PRN opioid orders who is requesting or requiring doses sooner than the allowed interval please call the provider and ask for additional orders. Perhaps the NSAIDs or acetaminophen needs to be scheduled during this the acute phase of this illness or injury. Perhaps another adjuvant needs to be ordered or the dosage of the opioid could be increased. If the patient is on hospice, the case nurse will want to review and adjust the POC if the patient is not comfortable at all times...that is the goal. There should never be a reason that a patient waits for 60 minutes for a PRN pain medication, in any LTC facility.

I really appreciate this question. Pain and symptom control for patients in LTC is a special interest of mine.

It is nice to know there are people out there concerned about this issue in LTC! KUDOS to you!!!!!!!!!

[carbaminohemoglobin]

I always believed the +1/-1 window was for scheduled medications only and prn's (narc or otherwise) adhere to the order with no leeway.

[FLArn]

As stated earlier, I wouldn't give prns an hour ahead-- but I'm not sweating 5,10,15 minutes. By the time I go to the med cart, pour the med, get water or juice to give the med with, walk down to the patient's room--stopping along the way to put the climbers' legs back in the bed, etc. the extra time is gone. If your patient is asking for the prn a hour or more early then the dose ordered is not sufficient to control the symptom and new orders are needed!

[PammyRN,CEN]

I was taught the same way, the 1 hr before or after does not apply to Narc's. I am in Ohio. Q4 means q4.

[supernurse1230]

your thought was right, q6 prn, means just that, Q6

[tewdles, RN]

Please...if the person is asking for more pain med in 5 hours and the order is Q6hr prn, call for addtional or new orders.

Thanks

[WorkinMama]

Clarification: So if there are routine meds every 4 hours and the patient is 1/2 out from the beginning of the window normally allowed you would....

[FarrellGirl,RN]

I always adhere to the hour. But I work on a secure dementia unit. If they're asking for it (which few of my residents ASK for meds), I'll get an order to increase the dose. What irks me is when someone writes an order for something "BID PRN". TID is no big deal. I can see a Q8. Or QID...I can understand a Q6. But BID PRN for a med like xanax or percocet for a resident that is ALMOST always anxious around the same time of day (I work with a lot of sundowners) and could use an anxiolytic twice a day, but within about 6 hours? It needs to be written, "Q6 with a maximum 2 doses per day". But, as I said, I work a specialty OF a specialty in my facility since they're all advanced age and dementia, usually with psychosis or behavior disturbance. Though a lot of nurses I work with don't understand that their agitation is sometimes a result of pain.

I love knowing there are other nurses out there who really care. The place I work at makes me think we are few in number (those who actually do the job and care enough to assess and make them call to get the increase order). Though I will say, there is one scenario where I do fudge things and that is with a patient who is actively dying. I don't like waiting to relieve their pain and anxiety.

[tewdles, RN]

FarrellGirl,RN...I really appreciate your mentioning that behavior changes and increased agitation may be caused by pain. I am afraid that too many of our advanced dementia patients suffer needless discomfort.