30 minutes leeway with PRN meds?

[parrotbaby]

With scheduled medications, I have 30 minutes before and after the scheduled time to give them. But what about PRN medications, especially pain meds that are supposed to be given every 4 hours? I have had some nurses say that it is okay to give PRN pain meds 30 minutes before the 4 hours are up, some say to wait exactly for the 4 hours otherwise the pts are receiving too much during the day.

[FireStarterRN, BSN, RN]

No, generally you don't have leeway on PRNs as far as my understanding.

[Sterling-RN]

I don't think there is leeway on prn's either. In fact, some doctors give orders that are expressly indicated that you wait the full 8 hours on a TID schedule. If you feel that the patient is having break through pain, then you can either offer them another prn they have ordered and isn't contraindicated, or call the doc and see if he will order something for breakthrough.

[Caffeine_IV]

I've never heard of a 30minute leeway with PRNs but I have occassionally given them 15mins ahead if necessary.

[leslie :-D]

we had a long thread about this very subject and remember not being able to find any tangible data.

however, it was generally agreed that prns have no leeway unless md specifies it on the order.

if my pts request their prns earlier, i get the order changed to reflect this need.

leslie

[inland18mempire]

our hospital says we have a 30-45 minute leeway for PRN medication, especially if it's for something like pain or vomitting. Given that, we are also told to use our "professional judgement". That means, if a patient is getting vicodin and you've been giving it a tad bit earlier around the clock, and the total acetaminophen is equal to or greater than 4g in a 24 hour period (for the average adult), then don't give it anymore.

[swirlygirl]

I work on a post-surgical floor and this question comes up alot regarding pain meds. We are allowed to give PRN pain or nausea meds 30 minutes early if needed. But I use my own judgment. Example: if a pt is ordered Dilaudid 2mg IV q2hr PRN, I won't give it early. But if it's a percocet or vicodin in a fairly young, healthy post-op patient, I'll usually do it.

[canoehead, BSN, RN]

Watch that patients who enjoy their drugs don't manipulate you into bringing prns early. It's a pain to retrain them for everyone coming after you, and they can manage an extra dose or two if it's given Q2H. If someone is in agony I'll give meds 15 minutes early, or call the doc, but I'd only give it early the one time.