Giving PRN meds- need some clarification

Specialties Geriatric

Published

I'm a new nurse working my very first job at a LTC facility. One of my patients has a prn narcotic and a prn anti-anxiety med. The orders say prn q4h as needed for pain and PRN q4h as needed for anxiety.

I may be wrong, being that i'm new and all but to me this means that the patient can get the drugs every 4 hours as needed, no sooner than that. I medicated the patient at 11:00 so the next dose was due at 3. This patient comes about every 4 hours like clock work because he " needs" these meds, so he approached me at 2:00 for his prn's and I told him he wasn't due until 3 pm so the nurse on the next shift would give him his next dose.

When the next nurse came in he got nasty with me asking why didn't I give the patient his meds when he asked at 2 . I told him that it wasn't time, 4 hrs were not up yet. This nurse then tells me that we have an hour before and an hour after to give meds so I should've just gave them to him at 2. I said to him that I think that just applies to regularly scheduled meds, not PRN's and I was not going to give are sign for any prn's early, certainly not narcotics. He continued to argue the issue with me and tell me I was wrong so I just left. Now he has me second guessing myself. What is the proper procedure for PRN meds?

The timeframe only applies to scheduled meds not PRN. That is why its necessary to indicate the time you gave it so that you will know the next time to give it. You did the right thing.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Seeeven though you are new you were right! good Job!!:yeah:

nikkicb2004,

If the PRN narcotic for this particular patient does not contain acetaminophen, maybe he can be offered Tylenol and the anti anxiety med. The combination of the two works quite well also for pain. Or any other OTC pain medication that may have been ordered for him. If he does not have any other order, perhaps this needs to be communicated to the doctor so that the doctor knows what is going on and this patient is aware that his pain concern is being addressed. My supervisor used to tell me that dialog with patients and giving them alternatives shows that you care, which you do, because of the fact that you asked the question.

And yes, your coworker sounds nasty.

Take care.

Specializes in Hospice, ER.

You were right as the other posters stated. PRN narcs and anti-anxiety meds are dangerous. If your coworker had to code the pt due to resp depression, he wouldn't have been very happy with that, would he? I tend to be blunt and my answer is "If I give you/your family member/the patient what they want when they want it I could kill you/them/the patient" tends to shut that conversation down. Then discuss with the MD. This patient may need pain management vs. tossing pills down his throat at random. This from a nurse who has given a lot of Narcan. You are a good nurse.

Specializes in Med Tele, Gen Surgical.

Well done Nikki! Way to keep your pt safe, your license safe, and way to leave a conversation that wasn't going anywhere with Mr. McNasty. :yeah:

Specializes in Psych ICU, addictions.

PRNs need to follow their schedule--the "window" rule doesn't apply. That being said, I may let a PRN slide if it's less than 15 minutes early and I can see the patient really needs it or may be unavailable for the next dose.

And if a patient is eating PRNs like candy...er, clockwork, then you should let their MD know as the PRN dose/schedule/medication may need to be adjusted.

Some patients will try to pull all sorts of crap on you, especially if they know you're new. You acted correctly IMO.

Sounds like the other nurse was just upset that a prn would need to be given right at change of shift.

Sometimes in this case, I would have given it 15 minutes early if the resident really needed it. If it seemed like it could have waited for the patient, then I would have stretched it into the next shift so that it could be retimed so it won't interfer with shift change etc.

Sounds like this person needs a med change too. We all fall into this trap..complaining or commenting on the person that need the prn like clockwork..instead of doing that, look at the pain level and call the md to suggest something different either stronger or longer acting and then seing if it helps.

Using a med like tylenol or motrin or other pain med inbetween shouldn't be overlooked too.

Specializes in Hospice.

At the facility where I work, PRNs come out of a machine and it will not let us pull them even one minute early. PRNs are on their own schedule based on the order. And yes, the doctor should be consulted regarding better pain management.

I also agree with the above comments..You did the right thing!

Specializes in Pediatrics, Geriatrics, LTC.

In my facility if a pt is usuing prn's more than QID they get a standing dose.

Specializes in Rehab and home health.

If the pt is asking for it routinely my facility usually asks the MD to make it routine.

Specializes in Oncology.

PRNS and narcotics cannot be given "an hour before or after." A few minutes maybe if the patient is going to therapy or going out for an activity, but no, this nurse just was too lazy to do a PRN and didn't want to deal with it so she yelled at you. You did the right thing by following the rules. If you gave it an hour after, then the next nurse gave it an hour early, or vice versa, the dosing would be inconsistent and messed up.. I admit I've had patients get "scheduled" narcs an hour late (too much med pass, one of the reasons I left LTC) But then in the morning I'd do their narcs again last, like half an hour after (that way if the next dose was on time and they weren't too spread apart, etc) but you shouldn't do PRNs like that, it could lead to you getting in trouble or harm for the patient, say if they became respiratory-depressed from excess roxanol or had extrapyramidal effects from too close together doses of something. I say no, your medication can only be give every 4 hours for safety of both you and myself from getting in trouble, your last dose was at 12 pm, I will be in at 4 pm or just after with your next dose. It's simple and most people understand it. If not, call the doc and say this patient has an issue you need to address.

+ Add a Comment