PRN meds

Guest757854 · Jan 8, 2014

Wait until they ask again. Although i usually tell them the time they can have it. I figure if they are alert enuff to ask for it now then in the next two minutes when its time they will ask then. Some patients do and some patients dont. And those that dont ask when its time i usually ask them if they are feeling discomfort....i just reassess their concern( pain itching nausea s.o.b.) for askin for the p.r.n. med.

MunoRN, RN · Jan 8, 2014

It's your responsibility to assess for the need for prn meds, it's not the patient's responsibility to ask at the time it's due. Typically, the frequency of a prn med is based on the length of time we expect the med to be effective. If an indication for a prn med is present, such as pain, and we give a medication that should be expected to wear off in 4 hours, we should be reassessing at 4 hours. Nursing care should be Nurse initiated, not just by specific request of the patient.

Here.I.Stand, BSN, RN · Jan 12, 2014

I'll explain when pt can next have med, and do whatever non-pharm interventions I can--heat, ice, reposition, massage etc. When they can have a med, I'll go to the pt to assess their need for more med. I'm guessing if they had pain an hour ago, by now it's likely worse. Like MunoRN, I feel the onus is on me to assess and intervene, rather than wait for the pt to tell me what I as his RN should be doing for him.

Now, if the pt is in an abnormally high amount of pain (based on previous assessments with similar interventions), I'd immediately be contacting the provider to 1) determine if there is a reason for the pain (compartment syndrome, peritonitis, etc.) and 2.) get a better pain control order than the one that's not holding them for the full 4 hrs whatever.

Even if it's not an emergency, if the pt is consistenly reporting pain 3 hours after meds, then perhaps pain could be controlled better. There again I'd be contacting the provider about the effectiveness of the current plan.

morte, LPN, LVN · Jan 13, 2014

Hosp., LTAC, yup...but isn't going to happen in LTC with a 30 patient assignment.

It's your responsibility to assess for the need for prn meds, it's not the patient's responsibility to ask at the time it's due. Typically, the frequency of a prn med is based on the length of time we expect the med to be effective. If an indication for a prn med is present, such as pain, and we give a medication that should be expected to wear off in 4 hours, we should be reassessing at 4 hours. Nursing care should be Nurse initiated, not just by specific request of the patient.

mom-wife-nurse · Jan 13, 2014

Hosp., LTAC, yup...but isn't going to happen in LTC with a 30 patient assignment.

This is exactly how I feel. I try to go reassess them when it's due but we have lots of treatments on night shift and with 30+ pts, you just can't always do that.

caliotter3 · Jan 13, 2014

I had a resident who demanded her vicodin when night shift came on. Sometimes she wouldn't even wait for report to end. According to PM shift, she never demanded it from them. As many times as I asked her what was wrong, she would stare at me with the most defiant, hateful look and say nothing. So no assessment of a need, I left the room. The call light went back on. Spanish stand-off. I never was able to get her doctor to change the order to routine. Apparently, he was just fine with things as they were. The PM shift nurses laughed at me, the CNAs complained, and even her neighbors said I should give it to her just "because".

Nurseypoo82 · Jan 16, 2014

I work in LTC and I have some patients that I know are going to be in pain based on their Dx so I always ask during med pass if they are having pain ...on the other I am currently caring for a hospice pt that is end stage COPD and for him it takes a lot of strength for him to speak so I go off his appearance and vitals ... Which int the order for morphine it says pain or SOB ...I know 30+ patients seems like a lot to assess but you can assess them all while doing med pass and with time you get to know your residents and their behaviors which seem normal or when they are off . Just my opinion and experience

wirehead · Jan 16, 2014

If you're talking about pain meds, Munro makes a good point, we need to assess our patients pain before they come asking. The idea of pain medication is to prevent pain from progressing rather than just control break through pain. Pain is subjective, it's important to note if the medication regimen they're on is sufficient, especially if they come chasing you for it. Just because a medication is prescribed, doesn't mean it will work for that particular patient, or if they've been on it long enough, they may need to switch due to tolerance buildup. Too often, there is a stigma with pain meds as it relates addiction/dependence, and this can interfere with proper pain control.

TiffanyCrawford · Jan 25, 2014

I have had this same question.... Alert & oriented Patient asks for cough syrup at 1am but can't have it until 3am. At 3am patient is asleep with no noted coughing. Do you wake the patient up to ask if they still want cough med?

zombieeegirl · Jan 25, 2014

Definitely follow up with the patient to make sure their pain is under control and give the pain med as soon as they are allowed by the prn med. It is our job to assess and follow up with the patient.

mom-wife-nurse · Feb 3, 2014

I work in LTC and I have some patients that I know are going to be in pain based on their Dx so I always ask during med pass if they are having pain ...on the other I am currently caring for a hospice pt that is end stage COPD and for him it takes a lot of strength for him to speak so I go off his appearance and vitals ... Which int the order for morphine it says pain or SOB ...I know 30+ patients seems like a lot to assess but you can assess them all while doing med pass and with time you get to know your residents and their behaviors which seem normal or when they are off . Just my opinion and experience

I do assess all of my resident during my Med pass, however, I'm talking later on after my main Med pass.