HELP!!!question about prn med

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The order reads: Roxanol 20mg/ml give q2hrs PRN et qevening. I gave a dose at 1930 which I signed off as PRN, my med aide was to give the evening dose at 9pm. She is refusing to give because it hasn't been 2 hours. I was under the impression that you can still give the scheduled dose and not have to wait 2 hours for the PRN dose (to treat them like 2 seperate orders)? Am I right or wrong??

Specializes in Pediatrics, Emergency, Trauma.
It DOES NOT matter who is right or wrong here.

What matters is this patient is not getting ADEQUATE pain control.

Call a team conference including pharmacy, the physician , ethics committee, etc.

Please get the patient comfortable.

THIS.

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Well, maybe I'm just tired and sleep deprived, but the first thing I noticed about that order is there is no dose.

"roxanol 20 mg/ml" is not a dose. It's simply the concentration of the medication in the liquid.

If the doctor wants the dose to be 20mg (a pretty high dose, but not unheard of), he needs to write "roxanol 20mg/ml. give 20mg (1 ml) SL q 2hrs PRN"

Or, if the dose is 10 mg, it should be written: "roxanol 20mg/ml. give 10mg (0.5 ml)" and so on.

This is the first thing I noticed as well. It needs to have a specific dose. I would have given the routine dose as ordered. It is a pretty high dose but we actually have a man that gets 40 mg (2mL) four times a day. We also have some people who receive their Roxanol hourly.

Now if the routine was due at 2100 and they complained of pain at 2130 then I would attempt other measures to make them comfortable to give the routine dose time to take effect.

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I would assess the pt's pain and sedation level. If pt. is not overly sedated and pain level high, I would give the scheduled dose. I would also look at how often the pt. is getting the prn roxanol, was this the 1st. prn dose of the day or the 5th? I would probably wait at least an hour after the scheduled roxanol before giving the prn dose, but again, this would be based on my assessment of the pt.

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