PRN Narcotics? - page 2

Okay... We all know in LTC we have a window of 1 hour before to one hour after to give a sched medication even if it is a narc. ie. sched at 5p can give it anytime between 4 and 6p. My... Read More

  1. by   carbaminohemoglobin
    I always believed the +1/-1 window was for scheduled medications only and prn's (narc or otherwise) adhere to the order with no leeway.
  2. by   FLArn
    As stated earlier, I wouldn't give prns an hour ahead-- but I'm not sweating 5,10,15 minutes. By the time I go to the med cart, pour the med, get water or juice to give the med with, walk down to the patient's room--stopping along the way to put the climbers' legs back in the bed, etc. the extra time is gone. If your patient is asking for the prn a hour or more early then the dose ordered is not sufficient to control the symptom and new orders are needed!
  3. by   PammyRN,CEN
    I was taught the same way, the 1 hr before or after does not apply to Narc's. I am in Ohio. Q4 means q4.
  4. by   supernurse1230
    your thought was right, q6 prn, means just that, Q6
  5. by   tewdles
    Please...if the person is asking for more pain med in 5 hours and the order is Q6hr prn, call for addtional or new orders.

  6. by   WorkinMama
    Clarification: So if there are routine meds every 4 hours and the patient is 1/2 out from the beginning of the window normally allowed you would....
  7. by   FarrellGirl,RN
    I always adhere to the hour. But I work on a secure dementia unit. If they're asking for it (which few of my residents ASK for meds), I'll get an order to increase the dose. What irks me is when someone writes an order for something "BID PRN". TID is no big deal. I can see a Q8. Or QID...I can understand a Q6. But BID PRN for a med like xanax or percocet for a resident that is ALMOST always anxious around the same time of day (I work with a lot of sundowners) and could use an anxiolytic twice a day, but within about 6 hours? It needs to be written, "Q6 with a maximum 2 doses per day". But, as I said, I work a specialty OF a specialty in my facility since they're all advanced age and dementia, usually with psychosis or behavior disturbance. Though a lot of nurses I work with don't understand that their agitation is sometimes a result of pain.

    I love knowing there are other nurses out there who really care. The place I work at makes me think we are few in number (those who actually do the job and care enough to assess and make them call to get the increase order). Though I will say, there is one scenario where I do fudge things and that is with a patient who is actively dying. I don't like waiting to relieve their pain and anxiety.
  8. by   tewdles
    FarrellGirl,RN...I really appreciate your mentioning that behavior changes and increased agitation may be caused by pain. I am afraid that too many of our advanced dementia patients suffer needless discomfort.