How early is too early to give a PRN med? - page 2

Hey all! I am a relatively new grad on med-surg-peds-telemetry unit. Lately, a lot of more experienced nurses have been telling me just to give the PRN meds early if the patient really needs it. As in "his pain was going up... Read More

  1. 0
    I would give it a little early. I do have a question...is it ok to give a prn Lortab 10 one hour before a scheduled Lortab 10? I had a resident request one and told him to wait until his routine was due. My boss said it is ok to give him the prn right before the routine since he asked for it. Seems like that is doubling up his meds. He is actually a fall risk, and addicted to them.

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  2. 1
    PRN meds have a time frame for a reason. I never give them early.
    Kittypower123 likes this.
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    We have to give a reason why we are giving a PRN medication early so by doing so it would require you to admit you are not following the doctor's order or not documenting that you are giving something. The only time I give something early is if it is due in 10 minutes and I have something to do so by not giving it early would require them to wait.
  4. 0
    as a former psych nurse, i gave prn meds no more than about 10 minutes early. if someone went off the deep end and a staff member yelled something like, "i need ____ for ___stat!" then i got and gave it after assessment.

    as the wife of a type-1 diabetic who took excellent care of himself for decades, annd despite that, developed several venous stasis ulcers on his right leg, i want him to be given his scheduled meds on time plus any ordered prn meds that he requests (though rarely) so he won't be miserable during and after debridement and pt sessions. when he's at home and taking his own meds, he doesn't abuse them and while he's in inpatient wound care rehab, i expect that his scheduled pain meds and his prn meds be given in a timely manner and as requested, after assessment (for prns.) to the few mostly older nurses who decide without bothering to assess his pain level,
    resps., how he looks, go get updated!
  5. 1
    When dealing with Narcotics, always follow the book. I wouldn't do anything with them you couldn't flip open your Policy and Procedure Manual for your facility out and point to the line that will save your license. Pharmacies now have automated systems that run audits to see if Nurses are:

    1. Giving more PRN Narcotics than their Colleagues.
    2. Giving Narcotics more Frequently than Collegues.
    3. Wasting according to Policy and Procedure.
    4. Using the smallest Mg Vial for the Mg Dose (Wasting More than Colleagues).
    5. Even Recieving Orders (VO, PO) for Stronger PRN Narcotic Analgesics.
    6. Moving back to IM, or IV after a PO has been ordered.
    7. Not even administering a PO if available and Ok(not NPO) before administering IV and IM Pain Meds (Narcs)
    8. Off Counts on more than one occasion on a certain nurse(the same two nurses always count in my last contract facility)

    You don't even have to be doing anything illicit to get redflagged, You may just be the nurse on shift who always gets the higher acuities for trade-offs, example IV nurse, PO med nurse, and Patient care nurses who take a load. One of our Pharmacists said that 95% of their RED FLAGs were cleared without any wrong doing.

    It was a real eye opener.
    LostCauseCCRN likes this.
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    Scary. Although I do notice the same nurses get tagged in discrepancies over and over again in my facility. Not that I think they're drug-using, but they tend to be the ones that get in a hurry and take 2 doses when they put they're taking out 1 (or vice versa) and/or forget to document.
  7. 0
    Quote from kiwibear99
    I would give it a little early. I do have a question...is it ok to give a prn Lortab 10 one hour before a scheduled Lortab 10? I had a resident request one and told him to wait until his routine was due. My boss said it is ok to give him the prn right before the routine since he asked for it. Seems like that is doubling up his meds. He is actually a fall risk, and addicted to them.
    Personally I wouldn't be comfortable doing this. I have always been told by the pharmacy consultants that PRNs need to be time specific ie. q4 hours, q6hours and not BID, TID to help avoid this specific issue of a resident basically getting a doubled dose. This way if a resident gets a routine dose at 9 AM and 5 PM say & the PRN specifies q6 hours then doses can't be given any closer than 6 hours apart. Make sense?

    In addition if you feel this resident is a fall risk but he has also developed a high tolerance to his Lortab I would suggest his pain control needs be reassessed by the prescribing medical provider.
  8. 0
    thank you everyone for the question and replies! helpful


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