There's a scheduled order to give Roxanol Q8, then there is a PRN order to give Roxanol Q4. The Q8 is being given at 6a, 2p and 10p. Does that mean I can only give the prn at at 10a, 6p and 2a?
I didn't think to question it because I thought just as you did *lumbarpain
and gave the med. To my utter shock I was reported to the DON for this and the DON herself said this was wrong and that there's something wrong with me for not knowing this. The PRN simply stated can give Q4 hours for pain or discomfort. And I was supposed to have used my nursing judgement and known that meant not to give it within 4 hours of the standard Q8 order.
I too am perplexed. I'm glad that so far all the feedback I've gotten is inline that what I did seems to have been correct but yet still leaves me ... confused.
Idk, I have many years ahead of me to gain more experience and I know this is just the beginning and I will learn so much more from many more nurses who will be as supportive to me as I feel when I come here.
Last edit by Need2Care on May 30, '12
Is the strength of the prn dose the same as that of the scheduled dose? If so, it seems to me that by giving a q8h order the ordering MD intended for the patient to receive a minimum of 3 doses within a 24 hour period and by leaving a q4h prn order the MD intended for the pt to receive the medication a maximum of 6 doses within a 24 hour period. To give the medication more frequently than q4hs, in my opinion would be wrong. Say the pt has a scheduled dose at 1000, the prn dose is then given two hours later at 1200 then again at 1600 followed by the scheduled dose at 1800. This means the pt is receiving the medication in 2 and 4 hour intervals when the order calls for 4 and 8 hour intervals. This also means the pt could potentially receive a total of 8 doses in a 24hr period. Two more doses than what then original order implies. After reading the comments posted I feel as if many nurses responding to this post feel like because there are two seperate orders here (scheduled and prn) you can give the prn whenever the nurse deams necessary using "nursing judgement" disreagrading the amount of time that has passed between doses. If you follow that logic you have essentially changed the intention of the original order. If the pt is requiring more medication for greater pain control the MD needs to be called and the prn medication frequency needs to be changed to ,for example, q2h. Still the pt should not receive doses more frequently than what is allowed by the prn order. So to answer your question if the "Q8 is being given at 6a, 2p and 10p. Does that mean I can only give the prn at at 10a, 6p and 2a?" I believe yes, the medication should only be given in 4 hour intervals. To solve this dilema in future situations you may ask the MD for a maximum dose allowed/per 24 hour period. This would prevent you from having this problem again.
Last edit by DYLANB on Jun 18, '12