Giving PRN meds- need some clarification

[nikkicb2004]

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?

[loriangel14, RN]

The one hour window applies to scheduled meds not PRN meds especially narcs.

[wooh, BSN, RN]

I've given the occasional dose a bit early (not an hour though), but when PRNs are being given around the clock, that's a slippery slope. If it's every 4 hours, the limit is 6 doses in a day. You start giving each dose an hour early, you're getting 8 doses in a day.

I'd have gone with what you did. :)

[CapeCodMermaid, RN]

The hour before and after does not apply to PRN's. You did the right thing.I would ask the doctor, though, to reassess the pain management. Perhaps switching to a long acting pain med might be the answer.

[CT Pixie, BSN, RN]

Our facility allows the hour before/hour after time frame for scheduled meds only. PRN's are followed to the T..if its every 4 hours and I give it at 12p it CANNOT be given again until at least 4 PM. Especially for controlled meds.

When in doubt check your facilities P&P book or check with your DON/ADON.

[NurseLoveJoy88, ASN, RN]

You did the right thing!! I occasionally give it 30 min early or so. Depending on the scenario.

[nicenurselpn, LPN]

You did the right thing. Scheduled meds can fall under the one hour/one hour after window. PRN meds are followed by the time frame in the order.

[debRN0417]

I agree with CCM- if the resident/patient is requesting medications before they're due, then the MD needs to know to reassess.

[sbostonRN]

I completely agree with everyone else. I will occasionally give a PRN narc 15 minutes early if it's close to change of shift or if the patient is going to physical therapy, but that's rare. The one hour window is only for scheduled meds.

[caliotter3]

I agree with everyone else. If a person needs the next PRN dose, I might give it a few minutes early, but by no more than 15 minutes.

[betterlatethennever]

PRN's do not fall under the same rules as scheduled meds as other posters have stated. Next time the oncoming nurse has something to say about how you do your job on your shift politely remind them that you too are a RN and will do your job as you see fit.

[thanhnguyen]

I'm totally agree with you. PRN meds does not fall in one hour window.