I'm hoping I can get some insight into this. What is your opinion or experience with this? First let me specify I work in an acute hospital psychiatric setting, not long term.
Ok, I can understand when the plan is for a patient to be going home in the next couple days, and you want them off the PRN benzo's and what not, since they need to be able to function without, since they won't be going home on them.
But I am frequently seeing where the doctor has PRN's ordered, the patient asks for them, but nurses are always saying not to give them. They don't need them, etc. Comments that they are just drug seeking, they like there narcs, etc. My thought is, we are not the doctors. It is not up to us to decide if they "really" need that medication. If the doctor doesn't want them to have it, then they need to discontinue it, or change the frequency if they feel they are abusing it. We can tell the doc we feel they are abusing it, not really needing it. But to me, it's like pain. If they say they are having it, we need to treat it. Regardless of our "opinion"
Now I can see not giving them an IM, when they have a po. Or offering a medication that is not as strong first, before going to the stronger if that doesn't help.
For example, we have a patient on one of the units now, who does have a DX of polysubstance. He had a PRN ordered for PO/IM zyprexa, as well as IM Geodon. I was flat out told by one of the longer standing nurses DO NOT give him the IM geodon, he doesn't need it. I did give it to him on my shift, because the zyprexa didn't work. He was pacing, fists clenching, slightly diaphoretic, just showing signs of escalating agitation. I'm not going to hold a med I have available, simply because someone else has deemed he "doesn't need it", because he is "drug seeking." Then end up having a take down, because I ignored the signs.
Now I am a new psych nurse. So maybe there is something I just don't understand yet. I'm not in any way trying to be hypocritcal, and judge the longer standing nurses. I am still learning, so I am trying to understand how to distinguish this.
But I am frequently seeing where the doctor has PRN's ordered, the patient asks for them, but nurses are always saying not to give them. They don't need them, etc. Comments that they are just drug seeking, they like there narcs, etc.
I was flat out told by one of the longer standing nurses DO NOT give him the IM geodon, he doesn't need it. I did give it to him on my shift, because the zyprexa didn't work. He was pacing, fists clenching, slightly diaphoretic, just showing signs of escalating agitation. I'm not going to hold a med I have available, simply because someone else has deemed he "doesn't need it", because he is "drug seeking."
Any insight is greatly appreciated.
Every place I've worked has had at least one nurse like this, they are everywhere, and they are ignorant. In addition to looking at her like she's stupid, tell her "It's a doctor's order. I have to give it".
If it's a supervisor telling you not to give it, then let her know that you have to chart why the medication wasn't given when the patient requested it-- because she told you not to. (ouch, she wont like that)
Whenever a patient tells me that they were denied their prn medications, I try to talk to the nurse first. If that doesn't work, I give the patient a statement of concern (complaint) form and encourage them to use it. I also include it in my report (patient complaining that he's not getting his prn medications) and I document everything.
The only time that I tend to hold back on prn medications is when the patient has been getting them frequently and their agitation is more like the cumulative effects of a drug (groggy and irritated similar to an erratic drunk). They usually need TLC and a quiet atmosphere so they can rest. But if that doesn't work, I inform the doctor of patients symptoms and encourage an alternative measure.
Pt states he felt like he was going to blow. This is a sure statement that he needed a prn. I'm a newer nurse as well and I would have given the geodon. I'm learning to take some of my patients at their word. Many times I've seen nurses ignore the pacing and the statements that are telling us this patient is going to lose it big time. This is the safety of the pt, other pts as well as staff. I've tried to let some ride it out, but more often than not, I end up calling security. After I saw a pt assault another pt, I've learned that I really need to have faith in my own assessments and my gut.
When a patient tells you he's going to blow, believe him. He wouldn't be saying it if he felt he had control over his behavior.
I'm not there so I really don't know.
Try to find out. It could help you determine the need for PRN's.
LaRN
272 Posts
Every place I've worked has had at least one nurse like this, they are everywhere, and they are ignorant. In addition to looking at her like she's stupid, tell her "It's a doctor's order. I have to give it".
If it's a supervisor telling you not to give it, then let her know that you have to chart why the medication wasn't given when the patient requested it-- because she told you not to. (ouch, she wont like that)
Whenever a patient tells me that they were denied their prn medications, I try to talk to the nurse first. If that doesn't work, I give the patient a statement of concern (complaint) form and encourage them to use it. I also include it in my report (patient complaining that he's not getting his prn medications) and I document everything.
The only time that I tend to hold back on prn medications is when the patient has been getting them frequently and their agitation is more like the cumulative effects of a drug (groggy and irritated similar to an erratic drunk). They usually need TLC and a quiet atmosphere so they can rest. But if that doesn't work, I inform the doctor of patients symptoms and encourage an alternative measure.