Non-Pharmacological interventions prior to distribution to PRN medications

[gamedoc14]

A while ago my facility initiated a soft protocol pertaining to giving non-pharmacological interventions prior to the administration of a pain or behavioral PRN. This is also how I was taught in school. However today an email was sent to give with the non-pharmacological interventions.

Now the preference of the nurse giving the medication aside. I feel like not only would this mask the results of the intervention this would also negate the reason for the intervention.

So my question is where are the articles and or regulation for this type of protocol so I may make an informed decision In the future.

[NurseMellie]

In my experience, the Centers for Medicare and Medicaid (CMS) and surveyors want to see nonpharm interventions attempted and very well documentation regarding those interventions before giving a medication. On the MDS, there is a pain section in which we have to document if Routine Meds were given, Nonpharm Interventions were tried and if PRNS were given. If I recall, the rationale is so that we aren't over medicating our residents or giving them medications they don't need. Some good resources are CMS.gov and your local state health department website.

You don't want to do the nonpharm and give the med at the same time. You want to try the nonpharm interventions first and give it maybe 15-30min to work. I have residents who I have specifically careplanned that they can ask for a PRN without attempting to do the nonpharm, these folks are fairly with it. And really those folks have tried to reposition if they can or asked a NAC to reposition them before even asking. This is where a dialog with your staff comes in. And I have had residents state "Asking me if I want hot Cocoa is stupid!" when someone asked them if they wanted some after they complained of pain. It was a new NAC, so she learned a lesson. So use the interventions that are appropriate.

As far as psych meds, you definitely want to be offering food/fluids, toileting, 1:1, quieter environment etc before giving those meds. And you want to document if those were unsuccessful. And have a dialog with your NACs have they been trying those things before you even were notified of the behavior? Chances are they were attempting in some way shape or form. There are certain, rare, cases to give the PRN without doing the nonpharm but those are tricky. The resident has to be harm to other residents or themselves or lashing out.

Heres two cases: 1) verbal altercation between residents. They are separated and assessed. After a few minutes they say they are not bothered by the incident, etc. No signs of harm or mental anguish. No PRN really to give. Now if someone was displaying some anxiety, try a 1:1 with them and allow them to talk. This often resolves the anxiety without issue.

2) A resident walks over and hits another resident for no reason (I've had this occur). Our facility protocol is that the aggressor in this situation gets a PRN immediately after the residents are separated.

[Mn nurse 22]

Our facility is asking the same thing but I guess if someone is telling me they are having 10/10 pain and they have an order for narcotics that I am not going to offer a warm blanket, toilet them, offer a snack, then Tylenol ALL BEFORE providing their medication that will still take 30-45 minutes to take effect?

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