PRN TID

  1. 0
    Say a medication (in this case ativan, dose is 0.5mg) can be give TID PRN. How far apart should the doses be spaced?

    Suppose the first dose is given and is minimally effective? How long should the nurse wait before re-dosing?

    There is more to this scenario, the nurse did not attempt any other interventions (Roxanol was also available, for example for pain r/t a rectal tumor and prostate cancer) and the pt. also had orders to straight cath if there was no voiding within a specific time frame.

    The nurse gave him a second dose a little over three hours later, which resulted in the pt. being "snowed" the rest of the shift. The on-coming nurse did straight cath for over 700ml...

    All of this has prompted much debate regarding the ativan. While I think she should have done a more thorough assessment and attempted some other interventions first, the real debate has revolved around the timing of the ativan dosing.

    What are the guidelines for PRN dosing? Can anyone help me find a resource for this?

    Some are saying TID PRN is equivalent to q8hours PRN. Others disagree...

    BTW...pt's anxiety is manifested by crying and repetitive behaviors...not dangerous, not disruptive to anyone around him.
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  3. 10 Comments so far...

  4. 2
    i would think that the order itself is inappropriate.....a time interval needs to be ordered.....peak is at 2 hours, half life of unconjugated is 12 hours..........who is to say, in this particular example however that it wasnt the disease process itself that initiated the change in MS?.....
    systoly and SunnyAndrsn like this.
  5. 0
    Quote from morte
    i would think that the order itself is inappropriate.....a time interval needs to be ordered.....peak is at 2 hours, half life of unconjugated is 12 hours..........who is to say, in this particular example however that it wasnt the disease process itself that initiated the change in MS?.....
    He was back to baseline the next morning, thanks, I'll requesting specific time intervals (Q8 hours)
  6. 0
    Quote from SunnyAndrsn
    He was back to baseline the next morning, thanks, I'll requesting specific time intervals (Q8 hours)
    you might compromise on q6.....does the patient have any routine order for HS? i am thinking 6/12/6 and what ever at hs......and keep an eye for increase agitation.....may need increase in dose with advance of disease....good luck
  7. 0
    three times in 24 hrs would be 6 hrs apart. but if you are uncomfortable with how the order is written, call the dr and get it clarified, get an order written differently- IE: Q6hrs prn.
    ya know?
    -H-RN
  8. 0
    Quote from NewRN2008
    three times in 24 hrs would be 6 hrs apart. but if you are uncomfortable with how the order is written, call the dr and get it clarified, get an order written differently- IE: Q6hrs prn.
    ya know?
    -H-RN
    Three times in 24 hours would be eight hours apart.
  9. 0
    i hate orders written like that...i am seeing more and more and more orders done this way...for example...our doc writes say "ativan po q 6 hrs prn for anxiety/agitation...." ...then the psych nurse comes in and says to change it to "ativan po qid prn for anxiety/agitation" with no time frame on it. pysch nurse claims if it has an hour time frame on it then it could cause us to get in trouble or cited when state comes in....i dont follow that reasoning too well...i feel safer with numbers...so when i look at those orders...i just assume in my head its q 6 hrs or whatever and thats what i go by. ...still ...it is confusing .
  10. 0
    This kind of order can be interpreted in many ways and needs to be corrected/avoided. If you are present while the order is given, ask the provider if every six or eight hours is ok. It's also helpful to have a facility protocol to cover this scenario.
  11. 0
    When you have orders like this, the best practice be to contact the prescriber and obtain an order clarification. I'm highly surprised TID PRN made it past pharmacy.
  12. 0
    QxH is more comfortable to me, too, but TID PRN is legitimate where the concern is not exceeding a certain amount within a 24-hour period. It allows a certain leeway where the problem centers around a specific kind of problem, say sundowning. I've seen it on imodium orders where it's supposed to be given p each bm but the doc's looking for a call from the nurse if 3 doses don't work. This seems similar in a way to a PRN Q5min x3 doses order for SL NTG.


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