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.
Specializes in Oncology/Hematology, Infusion, clinical.
It seems that if the patient is already in pain before the next dose is due, which I suspect is the reason for the request, then maybe current treatment is not adequately controlling her pain. Instead of just getting "off one's butt" and handing it out q4h, the nurse should inform the doctor of the need for a more effective regimen.
Not sure what your training is, but your answer is completely wrong.
Her pain should be re-assessed after the dose and also at least every 4 hours, she shouldn't have to call to have her pain assessed, and a pain assessment with pain that meets the requirements for the prn med should be treated, so no, she shouldn't have to call for pain meds unless she is having pain before the next pain assessment is due.
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 would have done the same thing.
It is not about laziness, it is about the order being written as needed. I, as a nurse, cannot tell you (nor can you tell me) what your pain level is going to be like in 6 hours, in 8 hours, in 12 hours.
I am happy to bring pain meds if a patient ask for them...when I give them pain meds I usually say, "You can have more at such and such time"...so when you feel the pain start to come back you need to ask so your pain is more manageable.
You will not appear to be a drug addict...in fact, drug addicts tend to want their pain meds brought to them right on the hour they are due around the clock while they are admitted.
PS: Whatever physican sent you home 24 hours post-c-section was an idiot and put your life at risk in doing so.
well it appears to differ from nurse to nurse but if you were my patient i would meet your request and medicate as soon as possible :)
Brandon2011, I agree with you.....We learn in school that we are to take patients seriously about their pain....and that pain is whatever a patient says it is where ever a patient says it is....However many seasoned nurses as I am sure you have seen, because I know I have seen them on my clinical rotations DENY patients their PRN pain medications. The reason the nurse feels the patient is a "drug seeker" Many of these patients may be drug seekers but a good number of them are not drug seekers. More importantly lets just say we have a patient who is a drug addict on the street, when they are in the hospital for issues such as acute pancreatitis they need pain control....so there need for pain control supersedes the fact that they have a drug problem.
Sorry this is a big issue of mine.....I do my clinical at Aria Health in the Frankford Section of Philly and we see many addicts and just because they have drug issues on the street, when they are in the hospital for other medical reasons when they have a need for pain control they deserve to have their needs taken care of. Remember these people could be your family and how would you want them taken care of.
well it appears to differ from nurse to nurse but if you were my patient i would meet your request and medicate as soon as possible :)
You would medicate without an assessment of pain?
No way would I bring a patient pain meds around the clock simply because they ask for them. If they were having pain, yes, they get pain meds on request....just as the order says.."as needed"...but there has to be a need. A need and a request are not the same thing.
Everyone has a different level of pain tolerance and I have seen Moms request nothing vs some mothers who has pain that is difficult to manage.
In L&D, for example, it is typical to see Percocet ordered where I can give 1 pill or 2. I am going to assess the pain, not just bring 2 in 4 hours just because the patient says that is what they want. If they have a pain level of 2 or 3, then they are getting 1 pill, if they have a 7 or 8 pain, then they are getting 2. If I give them one pill and they report little to no relief, then yes, they can have two the next round.
I had a Mom once that asked for her pain meds and when I asked her what her pain level was, she said, "Oh, zero...but I really need to sleep"...then proceeded to pitch a fit when I told her I couldn't bring them to her because they were written for pain and not so she could have a good snooze.
You should be assessing your patients regularly. When it's time for the next prn go and assess them then go get the med. SIMPLE How do you know if they need it if you don't assess them and ask?
I had a Mom once that asked for her pain meds and when I asked her what her pain level was, she said, "Oh, zero...but I really need to sleep"...then proceeded to pitch a fit when I told her I couldn't bring them to her because they were written for pain and not so she could have a good snooze.
Sounds like a great opportunity for patient teaching! You could help her environment be more conducive to rest. And if she really needed a sleep aid, they make PRN and one time orders for such medications, no need to deny her completely.
Not sure what your training is, but your answer is completely wrong.
I agree, PRN meds are ordered to be given as needed, not pre-ordered. I have had many patients complain because I refused to accept requests like this. NO, I will NOT wake you up from a sound sleep to give you your PRN's.
However, if I know that you have pain that has/continues to be difficult to control, I will watch you and if you are in pain I will offer you PRNs or just bring them to you. If you are running around laughing, going out to smoke, eatting everything in site, do not expect me to believe you when you suddenly run up to me (exactly 4 hrs after your last PRN). I will give you your med, because you requested it, not because I believe you need it. And I will document your behavior before and after recieving the meds.
i never requested to be awakened - lol - wow, how the story unfolds!
prescriptions usually say "every four hours OR as needed"
i could see the nurse needing to assess if meds were requested before 4 hours had passed which would justify the "as needed" portion. but if the md says every four hours i don't see how it's up the nurse if it has been at least 4 hours or longer.
I'm confused by the sheer number of posts that state that they never wake a patient for pain management. I thought the current literature was that if you don't medicate at night then the patient can wake up in a lot of pain and you're left chasing your tail? Could you explain a bit more why drawing such a hard and fast line is best-practice? Obviously it is per the patient's situation, and yes, sleep is a rare and crucial thing in a hospital, but here is a thread from a pain specialist talking about how patients need to be woken up for pain management purposes.
If a patient asked me to bring in their pain medications every four hours I would be in their room every four hours assessing their pain. As a nurse I try to anticipate needs and when a patient is having trouble with pain control that is a need.
I will also wake patients up for pain medications. Patients who sleep through the night and then wake up in severe pain in the morning need to be assessed in the middle of the night. Once pain gets severe it's hard to get it back under control. I will often ask the patient "You can have pain meds again at x time, would you like me to wake you up to see if you need them?" some will say no I will call and some will be greatful for the offer.
dthfytr, ADN, LPN, RN, EMT-B, EMT-I
1,163 Posts
To sum it up;
We disagree on the meaning of a PRN order.
We all want to keep our patients as pain free as possible.
Stated in differant ways, it's easier to keep a patient out of pain than to get them out of severe pain.
We have various ways of anticipating patient needs.