In nursing school 2 of my instructors forcefully stated that if we had an order such as
" Morphine IV 1-10 mg every 4 hours prn
" we absolutely were not
allowed to give, for instance, 1 mg of IV morphine, then an hour later, 2 mg of IV morphine, than another hour later, 3 mg of IV morphine.
This question is meant to focus specifically on the legal issues regarding a ranged timed medication order, and how we are legally able to time the meds we give, not any other aspect of this scenario.
Legally speaking, my nursing instructors said as RNs we were to make a choice from dose amounts from those available in the order (say, 1 mg), and then until the time frame listed (4 hours in my example) passed, our hands were tied and we were not allowed o give any more of that medication. At the end of the time frame (the 4 hours) we were then free to choose to give a higher amount in the range, say, 2 mg IV, then we would again need to wait 4 hours to medicate.
This issue has become a challenge in one hospital I work in. The unit I started in was in agreement with what my nursing instructors had said. In fact, the manager of our floor disciplined some of my coworkers who had given multiple doses within one order's time (for example, one had an order to give morphine IV 1-4 mg every 4 hours prn
, and had given 2 mg IV to start, and 2 hours later given another 2 mg IV).
Now I've moved to a different floor, and I am getting great pressure to give my patients multiple doses within one orders time frame (example, when I had an order for 2-4 tabs Percocet PO every 4 hours prn
, and I gave one tab, and the patient asked for another tablet of Percocet after 2 hours, my fellow nurses expected me to give my patient "the second" Percocet even though it had not been 4 hours since the first).
Obviously I don't want my patients to suffer, but equally obviously I don't wish to endanger my license by not respecting the time frame of the order. I know enough to ask other nurses, but the problem is that I get different interpretations from different nurses, and different pharmacists. One of my charge nurses actually told me "Don't think so much!" when I asked her about the situation.
How can I find out what the law requires of me, and what I am allowed to do, with certainty, in this situation?