Doctors orders

[new_worker]

Hello all i have a question regarding new orders. Say you have a patient with a pain and the regular standing orders are Tylenol 250 mg P.O q6h PRN. if you give them the pill and they are still in pain within one hour. What i would do is message doctor saying:

"MR. Smith complained about pain 4/10 in left upper quadrant, given Tylenol 250mg as per standing orders and it was ineffective, patient is still in pain 4/10. Any suggestions?"

and doctor replies, " Tylenol 500mg P0 B.I.D"

So i would chart in Nursing notes about the patients pain, sent doctor a fax about it and next send pharmacy the copy of the doctors orders. then begin with the pain med when appropriate correct. I have to contact family or not

So i have questions:

1) Am i missing anything??

2) Its not necessary to contact family is it? just double checking? or would you make them aware of it but it might go away but since its doctors orders maybe just update them on the situation??

Thanks all

[phayers13]

well, you were just following a doctor's order and besides it was all documented so you don't have to worry at all.

[tewdles, RN]

I would notify the family that the patient is painful. I would ask the MD for scheduled AND prn meds. I would clarify the type and severity of pain that the patient is experiencing...perhaps something topical would provide better relief. Perhaps you could alternate tylenol with an NSAID. Would the patient benefit from something stronger? (if the pain is moderate or worse the tylenol is not the med of choice). If the pain is neurogenic a different class of med may be in order.

I am glad that you made up the scenario because if a doc gave me that order we would have a problem...

Yay to the response that outlined non pharmacological interventions you might try.