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.
but then the next day when the narcotic is no longer necessary your stuck with an order. I guess we can all do things differently.
You forget that the patient has the right to refuse the medication. It's all matter of saying, "Mrs. X, I have your next dose of Percocet, do you still need it?" If they don't need it, the patient says No. Should patient decide she needs something for pain later, she can get that dose if it's still within the administration window, or get another PRN as most post-op patients often have a few different ones on order (Tylenol, Motrin, Naprosen, etc) to hold her over to the next scheduled dose.
Also, if you're concerned about patients getting narcs they no longer need, then do as agldragonRN suggested and say to the doctor "Mrs. X is requesting her Percocet every 4 hours, can we change the PRN to a standing order for the next day?" Then reassess the med order in 24 hours. And remember, patients can refuse the meds...after all, they are the authority on what their pain is, not us.
If the medication is scheduled and not PRN, then it's a lot easier to get the medication to the patient and have them refuse it, than trying to keep track of all the PRNs due for 8+ patients who may or may not wait their next dose of the med, PLUS keep track of their regular meds, PLUS everything else you have to do for them. This is not to say someone won't get a PRN: all they have to do is ask; I'll go assess the situation and if it's necessary I can give it them...and if I can't give it now due to the order parameters, they'll get it when they are able to get it.
It's not about making patients beg for meds. It's about providing good care to ALL of my patients as well as treating each patient as an individual.
I've seen the Nurse Ratchet's who insist the call bell be put on and the whole sherade of "asking" for it be performed before they will get the med. And if the pt. calls....just 5min. early....they say no and the whole song and dance has to be repeated again in 5 min. This is not nursing at all. Where are the assessment skills/autonomy/pt focus in that? Thats passive aggressivness, plain and simple.
Now, the line I won't cross that I've had a lot of people ask me to do is........I won't wake people up in the middle of the night to give them a pill. If they ask me to, I'll stick my head in the door to see if they are awake. If they are sleeping, I leave them alone.
The first part...that's ridiculous that nurses do that. Most places have a window where they can give the PRN up to an hour early depending on the facility policy and what the PRN is. I agree, to do that to a patient is more torture than nursing.
And I agree with you on the second. I get asked that a lot as well, and I tell them that if you are sleeping I don't wake you up for PRNs. But I reassure them that if they wake up during the nap/night and feel they need that PRN, all they have to do is let me know.
The whole seeing if a patient needs a prn thing also completely depends on the patient! Is it a patient with s/s pain, or an out cold sleeping patient who loves to be asked in the middle of the night/nap if he wants another prn? I obviously know we don't know what the patient is feeling, and we need to use our assessment skills. But I think many of us can tell sometimes if it's a patient we should try to stay on top of their prn's (offer them, or at least check to see if they are up or not, or suggest it changed to a scheduled dose) OR the patient who requests their narcotic meds the second their eyeballs open and fall asleep by the time you get back with the med cup.
We do hourly rounds where asking about pain, bathroom and position is part of the checklist. So, I would be asking/offering the pain medications at the available intervals anyway and they can say yes or no.
I also do not wake people who are sleeping to give them pain medication unless they are comfort care or other specific circumstances.
I work on a post-surgical floor so all of our patients are ordered PRN pain meds q2-3 hrs. When we give a pain med, we must reassess in 1 hour and document their pain level on a 1-10 scale. I have had many post-op patients that request that I just bring in their PRN pain meds when they're due. I don't usually make it my practice to do that, I always assess them first as I've gone into many rooms 2 hours after a pain med is given and the next dose is due and they are sound asleep and snoring. I never wake a patient up to ask if they have pain. But I definitely try my hardest to keep my patients as pain free as I possibly can.
I consistently assess a pt's need for medication and often bring the PRN just as it is due, because I know they are going to ask for it and need it. Nothing wrong there, thats just good assessment skills. Assess the pt. needs the pain relief and needs it pretty much as frequently as its ordered and bring it to them. Thats simple. You'll find going this route will make your patients happy and make things easier better for both of you.
I've seen the Nurse Ratchet's who insist the call bell be put on and the whole sherade of "asking" for it be performed before they will get the med. And if the pt. calls....just 5min. early....they say no and the whole song and dance has to be repeated again in 5 min. This is not nursing at all. Where are the assessment skills/autonomy/pt focus in that? Thats passive aggressivness, plain and simple.
Now, the line I won't cross that I've had a lot of people ask me to do is........I won't wake people up in the middle of the night to give them a pill. If they ask me to, I'll stick my head in the door to see if they are awake. If they are sleeping, I leave them alone.
I agree. I anticipate alot of my pts requests for pain meds. (saves time..esp when that seems like that is all I'm doing some day) I might wake a person for pain meds on a rare occasion...if I know that not taking a pain med will cause the pain to be worse when they awaken and it will be hard to get the pain back under control. Again..this is only a person I know well and know that they need to keep on track with the meds.
Getting back to the OP..your meds were ordered PRN, so you need to ask for them. I hated "bothering" my nurses for things like this and suffered. I some good nurses that would make rounds and yell at me for not asking them for the meds. DUH!
nope, that is NOT what prn means, it means as needed....that means the nurse gets their butt into the patients room on or about the time it could be given and ASSESSES the patients pain and decides if it is needed.
This, this, this, this!!!
Shaking my head in disbelief that there is even confusion about this. and
Specializes in pediatrics, palliative, pain management.
The PRN discussion just about made me crazy, so I had to post without finishing this whole thread -- so I apologize if this has already been stated:
PRN does not mean a patient must ASK for it! It means as needed at the discretion of the nurse! Do you seriously require your patient to ask for all of their PRN meds or just the opioids?
As for pain meds PRN --- the correct way is that nurses know and understand the pharmacology of the medication they are giving and assess at the appropriate times and decide if future doses are needed. So with most pain meds (assess 45min after dose to ensure effect) the expected duration of action is typically 4 hours. Therefore it would make sense to assess your patient and offer them pain meds if you assess they need it.
C sections are painful and I would expect a patient who just had surgery to be in pain.
Pain is better managed when you stay ahead of it and medicate before the pain gets unbearable. A good nurse would assess pain every 4 hours without being asked to do so. Period
Specializes in pediatrics, palliative, pain management.
Just Googled PRN -- Here are the first 3 definitions.
as needed: according to need (physicians use PRN in writing prescriptions)
As the situation may require, more particularly directions on medical charts by doctors for the benefit of nursing staff indicating actions that may be taken at their discretion depending on patient condition.
administered as needed (from the Latin pro re nata).
I guess the web must not have included the "MUST INDIVIDUALLY ASK AT THE EXACT RIGHT TIME TO BE ABLE TO GET A MEDICATION" part.
Also..... seriously think about from a patient perspective -- (I love some of the OPs comments and that the OP is not yet a nurse, )! You know that you are going to be in pain (+++ Activity) had surgery etc, so you (as a non health care professional) are able to figure this out and are trying to plan ahead and prevent bothering the nurse... to only be told some ridiculous misinformed statements about how PRN works.
Okay it is time for me to stop trying to "correct the internet", ......
prn means as needed and you and the patient cannot predict that in 4 hours the med will be needed again. So the patient should ask for it and should be assessed each time it is administered. This is a JC standard.
prn means as needed and you and the patient cannot predict that in 4 hours the med will be needed again. So the patient should ask for it and should be assessed each time it is administered. This is a JC standard.
could you provide the citation for the bold part please....
and 
Meriwhen, ASN, BSN, MSN, RN
4 Articles; 7,907 Posts
You forget that the patient has the right to refuse the medication. It's all matter of saying, "Mrs. X, I have your next dose of Percocet, do you still need it?" If they don't need it, the patient says No. Should patient decide she needs something for pain later, she can get that dose if it's still within the administration window, or get another PRN as most post-op patients often have a few different ones on order (Tylenol, Motrin, Naprosen, etc) to hold her over to the next scheduled dose.
Also, if you're concerned about patients getting narcs they no longer need, then do as agldragonRN suggested and say to the doctor "Mrs. X is requesting her Percocet every 4 hours, can we change the PRN to a standing order for the next day?" Then reassess the med order in 24 hours. And remember, patients can refuse the meds...after all, they are the authority on what their pain is, not us.
If the medication is scheduled and not PRN, then it's a lot easier to get the medication to the patient and have them refuse it, than trying to keep track of all the PRNs due for 8+ patients who may or may not wait their next dose of the med, PLUS keep track of their regular meds, PLUS everything else you have to do for them. This is not to say someone won't get a PRN: all they have to do is ask; I'll go assess the situation and if it's necessary I can give it them...and if I can't give it now due to the order parameters, they'll get it when they are able to get it.
It's not about making patients beg for meds. It's about providing good care to ALL of my patients as well as treating each patient as an individual.