Meds: PRN or scheduled administration

[tntrn, ASN, RN]

Lately, in that ever-elusive quest for the perfect patient satisfaction scores, our NM has decreed that all pain meds are to be offered at exactly the time the patient could have them. That is to say, if they are ordered prn q 3, then we offer them q 3, without the patient having to request them.

Now she has declared that for post-op patients, they will be given q 3 (or whatever), even if that means waking the patient. This, she says, will improve patient satisfaction because pain will be more controlled.

I'm old, but if an order says PRN, that still means AS NEEDED, and that is the way I'm going to do it. If a nurse woke me up to give me a pain pill, I can guarantee that WOULD NOT improve my patient satisfaction. In addition, while I am not sure the docs know (yet) that this is being done, I feel if we are not following the orders as written, we are setting ourselves up for some nastiness from them, and maybe from the BON.

Anybody else coming up against this?

[Jules A, MSN]

What an interesting thread. I agree that pain management is super important fresh post op but can't say that I'd agree with waking a sleeping patient. It will be interesting to see what others think.

As for offering pain meds at the time allowed other than the extra work involved for the nurse or med aide I think that might be a good idea. I always worry that someone will be too shy to ask or that by the time they do ask the pain is so unmanageable we will be fighting a losing battle. For the record I don't think that post-op is the time to be too concerned about drug seeking/addiction issues. Just my opinion though.

[blinks14]

While I do strongly believe in adequate pain control for patients I ask my patients frequently if they are having pain and need to be medicated. I wouldn't give a pain med that is ordered PRN as a scheduled med. What if the patient does not want the medication for whatever reason? That won't really increase patient satisfaction either if pain meds are being forced upon them. And if I go to reassess pain after meds are given I don't wake them if they are sleeping, I chart that I cannot assess because the patient was sleeping and reassess them after they wake up.

Seems like another ridiculous idea from someone who is not involved in direct patient care.

[Jules A, MSN]

I wouldn't give a pain med that is ordered PRN as a scheduled med. What if the patient does not want the medication for whatever reason? That won't really increase patient satisfaction either if pain meds are being forced upon them.

I understood it differently in that the meds were to be offered not automatically brought or forced on the patients. OP?

[Melinurse]

I usually tell the patients I won't be waking them up to offer pain meds unless they want me to. I let the patients decide if they want to be left alone to sleep or not. Your manager sounds like mine. I've had a few patients request to be woken up to receive the pain meds but most say they want to sleep. However, if they do get up to go to the bathroom I will go in to ask if they need something. I do agree though that if it is ordered as PRN it should not just be given as a scheduled med. Of course, if they are in pain, or have been having issues through the day with pain, I talk to my patient and come up with a plan based on their needs and what is ordered.

[Flightline, BSN, RN]

I do like the idea of letting a patient know what pain meds the doctor has ordered for them and how often they can have them. In my own practice I usually ask if the patient has pain, and if they say, no, then I tell them, "Well, if you do, this is what you have for it...so, just let me know if you need something."

[SuesquatchRN, BSN, RN]

I think that what your NM has noticed is that some nurses give PRN's, some don't. I've worked with people who wouldn't give a stinking Benadryl because she "doesn't like drugs." Erm, okay.

She's trying to insure that nurse prejudice doesn't affect patient care.

Waking them if they're sleeping, though - nah.

[SharonH, RN]

I agree with Sue. There are some nurses who are so stingy with pain meds, it's cruel. Ever vigilant about drug-seeking, etc. blah-blah. I see nothing wrong with offering the meds q3-Offering, not giving. Some people have the same misgivings about taking pain meds as some nurses have about giving them. They want to be "strong", they don't want to become "addicted". Reassuring them that taking the pain meds will help keep their pain controlled and thus speed their recovery is a good thing.

But waking them up to do it is nuts.

[pagandeva2000, LPN]

I have no issues with administering or at least offering their pain meds as scheduled. It does decrease pain, and the patient will become less of a PITA. I really hate seeing the stingy, non-empathetic nurse hold out on the medications-that is a selfish thing to me because I am a pain sensitive person. When I anticipate pain, I prepare for it because I am such a baby. I can only imagine the suffering a person would experience behind that. Now, like Jules stated, there are many who are too afraid to ask, or due to cultural behavior, do not show telltale non-verbal signs of pain.

Now, waking them up...maybe not...if it is a prn. But, I would probably have to use judgement, based on previous observations of their behavior while they are awake. The pain may increase later because it was not consistantly administered (that happens to me often, so, I do wake myself up to take pain meds if I really need the continuum).

[leslie :-D]

exactly pagan...it's not totally unreasonable to awaken a pt.

esp if our goal is to stay ahead of the pain, rather than chase it.

when you have a pt that awakens to excruciating pain, many of you will think twice about awakening them to give the pain med.

leslie

[core0]

Lately, in that ever-elusive quest for the perfect patient satisfaction scores, our NM has decreed that all pain meds are to be offered at exactly the time the patient could have them. That is to say, if they are ordered prn q 3, then we offer them q 3, without the patient having to request them.

Now she has declared that for post-op patients, they will be given q 3 (or whatever), even if that means waking the patient. This, she says, will improve patient satisfaction because pain will be more controlled.

I'm old, but if an order says PRN, that still means AS NEEDED, and that is the way I'm going to do it. If a nurse woke me up to give me a pain pill, I can guarantee that WOULD NOT improve my patient satisfaction. In addition, while I am not sure the docs know (yet) that this is being done, I feel if we are not following the orders as written, we are setting ourselves up for some nastiness from them, and maybe from the BON.

Anybody else coming up against this?

Those who can't work the bedside manage. PRN means as needed. By giving PRN meds on a scheduled basis your risk for oversedation increases. Yes the patients will be happier but your code met (or whatever you call them) will go up.

When I write a PRN order its with the understanding that a nursing professional will assess the patient and give the pain medication as appropriate. I am relying on their professional nursing judgement to hold or give the medication as appropriate. To tell a nurse to give a PRN as scheduled completely negates any element of professional nursing.

I look at the amount of pain meds every day and discuss the need for changes with the nurses. If we have patients that are reluctant to ask for meds then we put them on scheduled meds or put them on longer acting meds. Thats the appropriate way to dose pain meds. Fortunately I work with a very professional group of nurses and their are rarely problems. On the rare occasion that I or the patient (or their family) feel that the pain meds are being withheld a little education usually is all it takes. If for some reason your nurse manager feels the patients are not getting adequate pain relief then the discussion needs to be had not only with the nurses but also with the providers to make sure everyone is on the same page.

David Carpenter, PA-C

[Pediatric4077]

Waking them? Who needs a pain pill if they can sleep through the pain? That doesn't make sense to me. Prn is as needed. End of story, not offered every time they can get it.