How early is too early to give a PRN med?
- 0Feb 22, '12 by leigh_86usHey 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 really quickly, so I just gave the pain med a little early." Or with anti-emetics. My question is, is it a standard practice in the "real" world to give PRNs early as long as the patient is stable/not oversedated? In nursing school I was taught not to give anything PRN early no matter what, and I suppose that is the safe way to play it.
- 3Feb 22, '12 by Nccity2002If you have the need to give PRN medications ealier (...and I am assuming you are referring to narcotics/sedation), consider contacting the MD and changing the frequency, backing the request by your assessment (increased pain/agitation).
- 1Feb 22, '12 by 0402I never give it early, but as a pp mentioned, if it's really necessary, contacting the MD may be the right answer. Depending on the pt/ situation, I will ask for a more frequent dosing/ increase in dosing or addition of a long acting medication in addition to the short acting PRN or I may ask for an additional 1 time dose to help really bring down the pain/ N/V, etc so that we are not trying to get ahead of such a high level of discomfort and reassess from there.
- 1Feb 22, '12 by Good Morning, GilIt's whatever you're comfortable with doing. If you're not comfortable giving it a little early, then don't do it. Just because other nurses do, doesn't make it right. I always do what I feel is right and what's accepted nursing practice. However, I do give PRN's a little early, as well....depending on patient assessment, and what the med is. If it's a prn zofran, yes, I'll give that 15 mins early. Nausea/vomiting is an awful feeling, and if it makes my patient more comfortable, I'll give it. IV phenergan early? and they're a little old lady? probably not...i'll do ginger-ale or something first. If it's prn dilaudid, and they just had 1 mg 2 hours ago, then they're waiting until the 2 hr mark; that's too close there. If it's however, a PRN lortab, and the person's been taking them at home for 15 years lol, and it's every 4 hours, I'll give that 10 mins early. If I find that my patient continues to want their pain meds 1 hr earlier than they should (which I never give them that early....only like 10-15 mins, and they really seem like they're in pain, I call the doc to change the frequency).
I don't work in peds, though. I work with adults, so I doubt you have any long-term chronic pain med takers on your unit lol. Or I guess you could if they have cancer or something, but it has to be more rare than the adult population.
- 0Feb 23, '12 by lpnfloridaSometimes it depends on the patient and their condition. If appearing lethargic, decreased respirations or slurred speech. I would not give it early at all. If not sedated I would consider giving it 30 min early. If med seeking, doubt I will give it early at all, especially if they are in the " so called habit" of requesting it early. I also will contact the doctor if it seems the patient is receiving poor relief from the current pain regime and others measure also have been ineffective. A medication with tylenol it in, I always check to see how much they have received within the last 24 hours before I give it .
- 1Mar 2, '12 by whatever...Best bet is follow your hospital's/work place rules or regulations on the issue. Just because if something happens, guess who management is going to throw under the bus??? The co-workers who told you, or you who has a license and did it??? Remember, take everything that anyone tells you with a grain of salt.
- 0Mar 4, '12 by romieIf you are consistently giving the PRN early, addressing the issue with the MD will not only correct the problem, cover yourself, but is the right thing to do. Having said that, assessing the patient and time management is foundation.
Try a verbal contract that you will give the medication as scheduled and writing down the times that you will be there and honoring that committment could work because it can alleviate some of the anxiety. Tell them " I can give you your PRN between ---- and ------. " Helps with the clock watchers. You are establishing a trusting therapuetic relationship, they trust that they are going to get their meds on time and you can actually plan your day a lot better. Doesn't work with all patients.
My patients say, "Thank god you are here! My pain was so bad earlier because..... and I know that you will give me my meds on time."
I'll give a pain med to a chronic pain patient who is alert/ oriented x3, not lethargic, normal respirations a pain PRN up to 20 minutes early especially before shift change and before wound care or other painful proceedures.
Giving a PRN before shift change for a patient you and your oncoming nurse who knows the patient does two things: 1. It reassures the patient that their pain is going to be managed and they wont have to wait for an extra hour for the oncoming nurse to recieve report and make his rounds and 2. It will be helping the oncoming nurse because then he doesn't have to worry about being interrupted during his rounds and knows the patient's pain is being managed.
Some PRN orders really should be scheduled. I hate seeing PRN orders for benzos for my detox and ETOH patients because some nurses may wait to long to intervene and then it's too late and you are dealing with DT and an out of control patient.
Experienced nurses before me will say, Thank you for giving him the Ativan because so many other nurses forget. So talk to the MD about having that order changed to a schedule.