Narcotic administration times

NOADLS · May 13, 2014

Patient education is the answer. Inform the patient that the medication needs time to work and that 30 minutes is not long enough to determine the effectiveness of the medication. In hindsight, if the nurse knew either 1) 1 tablet wasn't going to be effective or 2) the patient wouldn't shut up until they had both then 2 tablets should have been given at the time.

This is an ugly situation that I've seen time and time again where different nurses have different answers. Then there are the ones who add an extra line to indicate they've give two even if one was 30 minutes earlier.

_meow · May 13, 2014

I agree. What about if the 2nd tab was given an hour after the first, wouldn't that be considered giving the med q1hr, which is not what the order is?

THELIVINGWORST, ASN, RN · May 13, 2014

I would ask for clarification but, honestly, I would use my judgment to see when I would administer again.

Karou · May 13, 2014

It depends on the hospitals policy. What was the patients pain level? With my hospitals policy, if the patient stated severe pain then the patient in your example would get 2 tablets. If one was given and not effective the patient can get the second tablet, but then they cannot have the medication available again until 4 hours after the second tablet. The time restarts after the last narcotic given.

It depends on the policy though.

MunoRN, RN · May 14, 2014

The only general rules on this is that each facility must have a policy that provides a consistent understanding of how such orders will be interpreted.

Generally, the purpose of these orders are to define the maximum amount of opiate a patient can receive in a given timeframe. So for the OP's example, if you give 1 tab at 1400 you could give another tab at any time. If you give a second tab at 1500, you could give a single tab at 1800 (4 hours after the first tab) or two tabs at 1900. Basically, you look at how many tabs the patient has received in the previous 4 hours, if they've already gotten 2 then they can't have more, if they've only had one they can have one more, if they've had zero then they can have two. It's not really rocket science but for some reason we make it seem that way.

Mr. Murse · May 14, 2014

This kind of PRN order can be interpreted a couple of different ways, but I tend to agree with MunoRN's post above. It's the same idea with a PCA pump. If the 4 hour lock out dose is set at 4mg (or whatever), then the four hour window is starting from the current time and go back 4 hours, not starting at a specific past time and counting forward. So the window is always moving with the current time. It's the same with those meds (unless policy says otherwise). Look at what's been given in the last 4 hours and judge accordingly.

Usually though, for simplicity's sake I encourage patients to take either one or both at the same time, then wait another 4 hours for the next one.

FineAgain · May 14, 2014

Most of our orders state "May repeat in 30 minutes if not effective". If it didn't say that we can't give another until the specified time.

Here.I.Stand, BSN, RN · May 14, 2014

I do it like what MunoRN said. The order is for 1-2 tabs...well if you only give 1 and it's ineffective you still haven't given the maximum amount of the dose range. I've never been told you're stuck with the minimum of a dose range if that's what you've tried first, and our docs order dose ranges ALL. the. time.

loriangel14, RN · May 14, 2014

I agree. What about if the 2nd tab was given an hour after the first, wouldn't that be considered giving the med q1hr, which is not what the order is?

No because you only gave one tab.The order is 1-2. I would give one and if it was not effective give the other. Although as someone else pointed out, you have to give the first time to work.On our MARS we just write down how many we gave when there is a range.

chrisrn24 · May 14, 2014

I wouldn't. I just wouldn't like how it would look in our med admin book. At home I will tell my family to do this if they want. But at work I won't.

MunoRN, RN · May 14, 2014

I wouldn't. I just wouldn't like how it would look in our med admin book. At home I will tell my family to do this if they want. But at work I won't.

What is your concern with "how it would look"?