Let's say you have a rather innocuous medication, like milk of mag indicated for indigestion. The order is written as:
milk of magnesia 15 ml 2 x per day PRN.
Would you interpret it as:
Patient is given it at 0900 w/ relief, then is given it at 1700 w/ relief and the nurse informs the patient that he can't have it again until after midnight.
OR
Patient is given it at 0900 w/ relief, expresses indigestion again after dinner and the nurse informs the patient that he can't have it again until 2100.
I actually have a patient with a similar order. Polyeth glycol 1/2 cap "may give twice prn" usually AM nurse gives it with morning meds and holds if pt has diarrhea. And PM nurse only gives it if pt hasn't had a BM for more than 2 days. So that's pretty much like the first scenario.
I would take that to mean no more than 2 doses without a new order. And this brings up my own pet peeve - the people who write these orders are paid at least $100 per hour but I have to clean up their sloppiness.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
Two doses total in one day, for whatever the patient is getting it for. Timing per patient request. If he's not a happy camper after the second dose, time to call for an updated order.
I would interpret that as "M.O.M. 15-30ml q 24 hours". Exactly how this is interpreted is dependent on how the ordering physician intended it to be interpreted, which is often defined by facility policy. At least in places that I've worked, this would mean if the patient got a 15mls at 0900 they can have an additional 15mls at any time, but after that would have to wait until after 0900 the next day to get another dose. If you give 15mls at 0900, then another 15mls at 2100, giving another 15mls at 0100 would put them at 45ml over a 24 hour period.
And it's not at all unusual to strictly limit M.O.M. in renal patients so assuming it's a renal patient that might be already a pretty generous order parameter.
I would call and clarify the timing of the dosages. I realize it's only MoM, but it's the principle. At my facility, pharmacy won't even profile a PRN order that does not have the frequency specified.
If there is ambiguity, just call the person to clarify.
"Hi my name is X, I am the nurse taking care of patient Y. I called you to clarify the MOM order you wrote today for the pt. Do you want the medication at normal BID intervals or every 12 hours?"
Specializes in SNF, Home Health & Hospice, L&D, Peds.
I actually have a patient with a similar order. Polyeth glycol 1/2 cap "may give twice prn" usually AM nurse gives it with morning meds and holds if pt has diarrhea. And PM nurse only gives it if pt hasn't had a BM for more than 2 days. So that's pretty much like the first scenario.
In this situation I would get the order changed to q am and PRN and have the PRN specified i.e. 2 days without bm, NTE 2 doses/24 hours or something to that effect.
In this situation I would get the order changed to q am and PRN and have the PRN specified i.e. 2 days without bm, NTE 2 doses/24 hours or something to that effect.
Why get the order changed? The order is working fine as it is.
As written, I interpret it as he can get 2 doses a day as needed. Whether those doses are 1 hour or 12 hours apart would not matter, but all he would get is two...which would mean the patient is SOL if he used both doses in the AM and still needed relief come nighttime.
The order does need a better time frame attached to the dosing.
The nurse needs to stop telling the patient "they can't have it" and get the order changed to obtain the maximum benefit for the patient.
I think I need to go to bed.
But FIRST...
MOM is not the ideal solution for indigestion. So I am not sure why you would choose that PRN. What exactly does the patient mean by indigestion? In coordination with why the patient is admitted.
(ie: cardiac stuff can cause nausea, which is different...)
MOM is, as you know, a laxative. So you need to give it a bit to see if there are results. At the same time, a bowel protocol would be better served for this patient. And to have an alternate for the indigestion.
So if the patient is constipated I would see if you could get a more specific order. ie: MOM 15ml PO QHS PRN 2 days with no BM. Can be repeated x1 at 0700 if no results. (which is a horribly written order on my part....however....you get the gist)
Bowel protocols are wonderful things. Bowel obsessed patients are everywhere. Not all indigestion is due to constipation. So get an array of stomach stuff for your patients who are little old ladies who feel like their BM's were not "good ones" to the same patients who have fast food deliveries whilst laying in the bed.
There has to be timing. Especially since perhaps as early as tomorrow, the patient will need an anti-diarrhea medicine...
Ok, this is just an example. It's not real. Well, it's real as in the 2x/day vs q 12 hours, and I was interested in knowing how people interpreted. Just like NCLEX, no need to add information.
Kooky Korky, BSN, RN
5,216 Posts
I would take that to mean no more than 2 doses without a new order. And this brings up my own pet peeve - the people who write these orders are paid at least $100 per hour but I have to clean up their sloppiness.