okay, this could be a stupid question/story, but my degree is not in nursing - i start this summer
so, when i was in the hospital after a c-section (with my 2nd child) and my son was in NICU - i was prescribed to lortabs (2 every four hours). since i was staying in the hospital, i didn't have to go out and get a prescription - the nurse brought it to me...while i was there.
when i had my first child, i was released from the hospital the next day after my c-section - went to the pharmacy, and took MAYBE 5 or 6 pills once i was home. the rest stayed in my med. cabinet.
but with my 2nd child being in NICU and me being stuck at the hospital without being able to breastfeed, hold him, and do all the things new mothers usually do - i was a nervous wreck and stir crazy - wanting to walk to see him, wanting to walk to the ice machine, wanting to put on make up, wanting to go develop pictures - wanting to do ANYTHING besides sit in the hospital bed without my baby!
point being - since i was doing so much running around, i actually needed the pain meds this time. so, after about 6-7 hours without, i asked the nurse if i could have some and she was nice and brought them to me. i suspected that she'd bring me some 4-5 hours later. when she didn't, i asked again. she brought them to me. i asked if they could just bring them to me when they had the chance (around the time i was prescribed) because i would be needing them and i didn't want to bother them - and she said no, and that i had to ask for them. i felt like a drug addict begging for meds every 4-5 hours! i hated it. and after a few times of asking, i felt like THEY were treating me like one!
why do you have to ASK for pain meds in the hospital when they're prescribed after surgery? i'm sure there's a reason - it just made no sense at the time.
I don't know any experience nurse who would awaken a pt to ask them they needed a prn. We do NOT give prns w/o a pain scale assessment, so it isnt as though we could even admin something IV. I also do not ask pts if they want a prn, nor would I honor such a request as the OP. I would routinely visit the pt and inquire about pain. If at hour 4 he doesn't want anything he may actually have to make the effort at hour 5 to (gasp) press call bell. The OP struck me as unreasonable, entitled and likely abusing narcotics. At the very least, she completely misunderstands medication ores and the role of the professional nurse.
So instead of waking them up and asking them if they'd like their pain medication.. you'd rather them wake up an hour later in severe pain crying, have to wait for you to asses and bring the med and then wait for it to kick back in until they get relief? No thanks.. none of my rehab patients would go to PT! They'd be too tired!
The purpose of a PRN is for it to be used in the presence of certain circumstances and not to be used when those circumstances don't exist. Calling a doc to get the order changed to scheduled, when having it prn poses no barriers and allows for necessary flexibility, and then calling him back later in the day to ask if we can hold the scheduled dose or move it back an hour (since it is now scheduled) as the pt's pain is controlled at the time the scheduled dose is due is why MD's get annoyed with Nurses.
A prn is only to be used as needed, or occasionally. If your patient is using that med more frequently it's because it is needed more than occasionally and should be ordered as such. Your patient should not have to ask q4 hours for pain meds that are needed at regular intervals, use your nursing judgment to get the proper meds, dosages and frequency to keep their pain under continuous control. It's your job so do it properly.
I don't know any experience nurse who would awaken a pt to ask them they needed a prn. We do NOT give prns w/o a pain scale assessment, so it isnt as though we could even admin something IV. I also do not ask pts if they want a prn, nor would I honor such a request as the OP. I would routinely visit the pt and inquire about pain. If at hour 4 he doesn't want anything he may actually have to make the effort at hour 5 to (gasp) press call bell. The OP struck me as unreasonable, entitled and likely abusing narcotics. At the very least, she completely misunderstands medication ores and the role of the professional nurse.
:yeah:
LOL.
at the very least, you don't have very good reading comprehension skills.
and, for the record, if the nurse was ever asking about pain this wouldn't be a question nor would it have been an issue at the time bc i would've just said, "yeah, i'm having pain" and she would've brought me something or asked if i wanted something and i would've said, "yes."
that never happened. ever. after a couple times of what felt like chasing her down and asking "can i have meds" i asked "when am i supposed to get them, can u bring some when i'm able, etc" because at that point there was never any discussion and i wasn't ever asked about pain or explained to that i should ask when i needed something. the first time i had a c section, it felt like i was always being brought medication - i never asked for it, and i usually refused it.
after a couple times of what felt like chasing her down and asking "can i have meds" i asked "when am i supposed to get them, can u bring some when i'm able, etc"
Unfortunately, you are still misunderstanding the "as needed" order.
"when am I supposed to get them" -- there is no time that prn meds are *supposed* to be given. They can be given if needed, no more often than every x hours.
"can u bring some when i'm able" -- In other words, you have no idea when the next possible interval is that you could potentially be given a med, but you plan on having pain then, and are anticipating that pain, and want your nurse to bring you the med at that exact time? see above
"can i have meds" -- this is not chasing the nurse down -- it is maturely communicating a symptom - pain - to your nurse so that he/she can intervene.
A prn is only to be used as needed, or occasionally. If your patient is using that med more frequently it's because it is needed more than occasionally and should be ordered as such. Your patient should not have to ask q4 hours for pain meds that are needed at regular intervals, use your nursing judgment to get the proper meds, dosages and frequency to keep their pain under continuous control. It's your job so do it properly.
That's been my point all along. PRN pain med administration should be triggered by our pain assessments, and pain should be assessed whether the med is ordered as prn or scheduled. These assessments should occur when the med should have taken effect, as well as when it should have lost effect, which in the case of Vicodin and Percocet would be about 4 hours after it was administered.
If they need it every 4 hours and it's ordered ever 4 hours then there is no reason to change the order. How do you define "occasionally"?
Unfortunately, you are still misunderstanding the "as needed" order.
"when am I supposed to get them" -- there is no time that prn meds are *supposed* to be given. They can be given if needed, no more often than every x hours.
"can u bring some when i'm able" -- In other words, you have no idea when the next possible interval is that you could potentially be given a med, but you plan on having pain then, and are anticipating that pain, and want your nurse to bring you the med at that exact time? see above
"can i have meds" -- this is not chasing the nurse down -- it is maturely communicating a symptom - pain - to your nurse so that he/she can intervene.
you have no idea when the next possible interval is that you could potentially be given a med
exactly - you see no issue with that? if the nurse is supposed to be assessing pain at some point, any point - i should have some idea. yes, when you're within 24-48 hours of having surgery, you can pretty much count on being in some pain in 4-6 hours if you're having significant pain at the time.
That's not true or I hope you meant to say statistics show African Americans and red heads have LOW TOLERANCE for pain.
Pain and Ethnicity in the United States: A Systematic Review. Journal of Palliative Medicine; Dec2006, Vol. 9 Issue 6, p1454-1473.
"Abstract:
Background: Evidence suggests that racial and ethnic disparities exist in access to effective pain treatment.
Purpose: To review evidence of these disparities and provide recommendations for care and further research.
Design: Systematic review Methods: We conducted a MEDLINE search using the MeSH terms of ethnic groups, minority groups, pain, analgesia, and analgesics. We included studies describing current practice patterns, utilization of available treatments, treatment outcomes, and patient and provider knowledge, attitudes, and behaviors.
Results: Our search identified 35 journal articles describing the effect of patient race and ethnicity on pain assessment and management. Three studies on pain assessment revealed that minority patients are more likely to have their pain underestimated by providers and less likely to have pain scores documented in the medical record compared to whites. Eleven of 17 studies found that African Americans and Hispanics are less likely to receive opioid analgesics and more likely to have their pain untreated compared to white patients. Three studies revealed that minority patients are more likely to have negative pain management index (PMI) scores—undertreated pain—compared to whites. Patient-related, provider-related, and pharmacy-related barriers to effective pain management were identified.
Conclusion: The majority of studies reveal racial and ethnic disparities in access to effective pain treatment akin to disparities found in other medical services. Quality improvement initiatives that improve treatment of pain for all patients according to established guidelines should decrease disparities by race or ethnicity. Educational interventions should aim to improve patient-provider communication regarding pain and its treatment and should provide support around substance abuse issues. Further research is needed to examine pain treatment outcomes and to determine whether health care system factors lead to these disparities."
I don't know any experience nurse who would awaken a pt to ask them they needed a prn. We do NOT give prns w/o a pain scale assessment, so it isnt as though we could even admin something IV. I also do not ask pts if they want a prn, nor would I honor such a request as the OP. I would routinely visit the pt and inquire about pain. If at hour 4 he doesn't want anything he may actually have to make the effort at hour 5 to (gasp) press call bell. The OP struck me as unreasonable, entitled and likely abusing narcotics. At the very least, she completely misunderstands medication ores and the role of the professional nurse.
As has been re-asserted many times in this thread, we all agree that we need to assess pain prior to giving pain meds. So the question is: does a patient have to call to have their pain assessed every time or are there logical time parameters when we should be assessing pain without being asked, such as when we know the pain med would be wearing off. It sounds as though we agree that the patient should not always have to call to have their pain assessed, although there are times when this responsibility is shared by the patient. It's not unusual for patients who are having trouble staying on top of their pain make requests similar to that made by the OP for fear of getting behind on their pain control, and it's completely appropriate to explain that you can't just give them but you can assess their pain at regular intervals; this was not an option provided to the OP.
I am curious as to how you came to the conclusion that the OP is likely abusing narcotics?
you have no idea when the next possible interval is that you could potentially be given a med
exactly - you see no issue with that? if the nurse is supposed to be assessing pain at some point, any point - i should have some idea. yes, when you're within 24-48 hours of having surgery, you can pretty much count on being in some pain in 4-6 hours if you're having significant pain at the time.
I understand where you're coming from OP, esp with myself having a recent surgery.
Pain pills DO NOT last 4 hours (not for my surgery they did not) and who ever said they do is very wrong.The pain pills basically took the edge off for maybe 2 1/2 - 3 hours in my case.
In the hospital I work, our management makes us tell our pt what time his/her next pain med is due. And, I can tell you that most, if not all, pts call about 5 minutes before this time.
Also as a nurse, I inform my pts of all available prn meds that dr has ordered for them with the times due. And I educate them that these are "prn" meds and must be asked for. I do this as a consideration for my pts because I have been on the other side of pt care many many times and I treat other's the way I would like to be treated myself. These are my thoughts!
I am curious as to how you came to the conclusion that the OP is likely abusing narcotics?
thank you MUNORN
this is what I was trying to explain/get at earlier in my posts when I was called a self righteous student, or something along those lines. But it just seems to me that more times than not nurses get burnt out dealing with actual drug seekers and then when they have a patient that is a truly in pain that patient suffers. I have just seen it so many times, and my instructors have told us that it is par for the course that too many of the nurses think that way. It is really sad to see the patients that need better pain control and the nurses don't want to bring them their medication, or call the Dr, for an change in medication because in the nurses opinion the patient is just another drug seeker. Its criminal to not treat a patient that is TRULY in pain, IMHO. I know all you seasoned nurses think I am wet behind the ears but, if it were my mom, my daughter or me I would want to be taken care of. :heartbeat
I am curious as to how you came to the conclusion that the OP is likely abusing narcotics?
thank you MUNORN
this is what I was trying to explain/get at earlier in my posts when I was called a self righteous student, or something along those lines. But it just seems to me that more times than not nurses get burnt out dealing with actual drug seekers and then when they have a patient that is a truly in pain that patient suffers. I have just seen it so many times, and my instructors have told us that it is par for the course that too many of the nurses think that way. It is really sad to see the patients that need better pain control and the nurses don't want to bring them their medication, or call the Dr, for an change in medication because in the nurses opinion the patient is just another drug seeker. Its criminal to not treat a patient that is TRULY in pain, IMHO. I know all you seasoned nurses think I am wet behind the ears but, if it were my mom, my daughter or me I would want to be taken care of. :heartbeat
There are many times I don't like medicating a patient with 2mg of dilaudid every two hours
that calls every two hours. That gets very frustrating because I know most likely they are
an addict, but really, it's not up to me to decide. I give the med as ordered and that's all I
If you weren't being assessed for pain on an ongoing basis post-op you should have been. When being assessed if you stated you were still in pain the PRN drugs should have been given as long as they were within the proper timeframe. It seems the pain the OP experienced was on par with her surgery and how most patients in similiar situations respond.
:yeah:
anonymous1919, LPN
249 Posts
So instead of waking them up and asking them if they'd like their pain medication.. you'd rather them wake up an hour later in severe pain crying, have to wait for you to asses and bring the med and then wait for it to kick back in until they get relief? No thanks.. none of my rehab patients would go to PT! They'd be too tired!