Why, thank you Kymmi. For a second there, I thought I must be an idiot! Glad someone agrees with me
Hogan - yes I can have it both ways. Lopressor is a scheduled BP med that the pt needs. If they say they are not going to take it, or not going to take all of it, and their BP/HR is high, I am calling the doc. If their pressure is 104/62 HR 68 and they say that they don't take it at home when their pressure is like that, I chart "refused" and in the comments state why. If they do that more than once, doc gets a note on the chart about it. We have a dropdown menu in med admin for reasons why we didn't give a med, and "refused" is an acceptable choice. After all, the pt has the right to refuse any treatment that they don't want. PRN pain meds are different. If the pt doesn't take them at all, should I call the doc and tell him that??
And the docs don't "glean" anything from my charting. They sign onto their computer program and read it. There is no difference between them looking at the pt's VS and labs vs. them looking at the MAR. And they do look, especially at pain meds.
I do not HAVE to call the doc because the pt wants only one perc instead of 2. That's ridiculous. No wonder docs get annoyed with nurses if you are going to call them for every little thing.
I work palliative care. I give a LOT of pain meds. The pts have choices. If they have scheduled pain meds, they get them ATC. That happens quite frequently where I work. The people who have ATC pain meds usually need them. That's different from someone who had surgery a couple of days ago and has percs ordered prn.
I would never suggest that a pt take anything different from what is prescribed, and I would never give more than what was prescribed, even if they ask for it. That's when I would call the doc. But if taking fewer pain meds is effective, good for them. I hate the way perc makes me feel, and I can totally understand why someone would only want the minimun necessary to control their pain.
Say the order is for 10 mg oxycodone Q4 prn. If the pt asks for just 5mg, you can give 5mg, but if they want more before the 4 hours is up, then you have to call. The order is for 10 q4, not 5 Q2. As I said, that is considered normal procedure for us.