Even though this is regarding psych nursing, I'm posting it in general as it can apply to any type of nursing, and others may still have some good insight, opinions, or advice.
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.
Specializes in Med/Surg, Neuro, ICU, travel RN, Psych.
not sure how it works where you are but here in our psych ward prn medications can only be given if the prescribing clinician has completed the "indications" section of the med. chart - - in other words, if they have detailed the specific conditions that must be present for the prn to be utilised... - if this section of the chart is incomplete, it is considered a medication error to administer this medication and the nurse administering the prn will get support and instruction on how and when to withhold meds and address the issue with the medical officer (or immediately with any medical officer if the patient is suffering)!
we have to have indications for all ordered medications. but that indication is usually`just anxiety or agitation or something for the prn's.
Simply Complicated
1,100 Posts
we have to have indications for all ordered medications. but that indication is usually`just anxiety or agitation or something for the prn's.