Just my hospital??

[shortstuff31117]

Just the other day, a new policy became official in my hospital. We can no longer give meds on a range schedule. Like 1-2 Percocet Q4 hrs. Now we have to give 1 and then if the pt. needs it we can give another in a half hour. We all think this is ridiculous and is only going to cause our pts more harm as they get behind on their pain management. Are any other hospitals doing this? I'm not sure who made this decision. :angryfire

[bigsyis]

When I last worked in a hospital (2 yrs ago) they had just changed that type of order requirement. The order had to be written:

Percocet 1 tab q4 hrs PO PRN pain

OR

Percocet 2 tabs q4 hrs PO PRN pain. If there was a choice as to frequency, say every 6 hours, instead, they order would have to be entered again for every 6 hours. Since this was an electronic MAR, you conceivably have to search half your available screen to find the appropriate choice. Woe be unto you if you made a choice, and then went to the electronic Narc machine and signed out a the med under a different choice!

What a mess, and we haven't even begun to discuss patient pain management...

[nursechris1]

We have standing orders for Hospice. We might have 3 things listed for a symptom, like constipation. We were asked by a surveyor, "How do the nurses know which med to start with?" They say we are prescribing if we choose which med. The doctor signed the orders, basically saying "I don't care which you give". Sometimes, I would just like to be treated like I have a brain.

[anonymurse]

We have had MAKs for about 2 years, and since then, instead of a range, we'll see 2 orders in the MAK for the same med, like 1 tab q4 PRN pain, and another for 2 tab q4 PRN pain. Works.

[SmilingBluEyes]

It is a JCAHO recommendation slash/mandate. Range dosing is not allowed many places now. I think it is very stupid and yes, in many cases, will cause more problems than anything else, particularly in surgical cases where two percoset are really needed on schedule to keep pain under control. It's forced some people to play games with signouts/times, etc. E.G. giving percoset more like 5 or 10 min apart to keep patients appeased. OR coaching patients to qualify their pain as "severe" e.g., 6 or 7, to get the full dose. Definately a horrible thing. It eliminates nursing judgement, as well, which is what is drilled into our heads all throughout nursing school.

[SmilingBluEyes]

Of course the doctors know this policy; they sign off on the standing orders!!!!

They have no more choice than we; JCAHO is bigger than they are as well.

Those of you not doing this who are JCAHO-accredited, it will be coming to you!