Administration of PRN narcs too close to scheduled meds??

[pumpkinspice]

Hello,

I've been unable to find a clear answer for this scenario despite my research efforts. I'd really appreciate any input! Thanks in advance!

A resident has prn dilaudid q4h and scheduled dilaudid at 0600hrs. If she requests the prn at 0400hrs, could I still give the scheduled narc at 6 even though it's only 2 hrs from last dose?

Does the prn q4h only mean having to wait 4 hrs between PRNS or does it include scheduled meds too?

Thank you!

[Mandychelle79, ASN, RN]

Everywhere I have worked they are considered seperate orders. So I would give the scheduled. The way our emar is set up though others nurses may not because it would take time to research if it was the prn dose vs the standing dose. Is there any a difference in the dosage? Like say for Ativan I may give 2 mg bid scheduled and then 0.5 mg q4 hrs for anxiety.

[Sour Lemon]

Hello,

I've been unable to find a clear answer for this scenario despite my research efforts. I'd really appreciate any input! Thanks in advance!

A resident has prn dilaudid q4h and scheduled dilaudid at 0600hrs. If she requests the prn at 0400hrs, could I still give the scheduled narc at 6 even though it's only 2 hrs from last dose?

Does the prn q4h only mean having to wait 4 hrs between PRNS or does it include scheduled meds too?

Thank you!

I treat them as separate orders.

[quiltynurse56, LPN, LVN]

I am with the others and treat them as separate orders.

[pumpkinspice]

Thank you for your replies! Yes both same dose of 1mg. I know it wouldn't be detrimental to give that low dose 2 hrs apart but just was wondering the proper way to administer

[TraviesaRN]

Thank you for your replies! Yes both same dose of 1mg. I know it wouldn't be detrimental to give that low dose 2 hrs apart but just was wondering the proper way to administer

Make sure to ask if your facility has a specific policy regarding this. I have worked at two hospitals that did and their policy's were both very different. So always best to check so you don't end up in trouble. I have generally always followed it the way the others suggested.

[Cruella de ville]

I think the MD would have added parameters if they had wanted them in place and is hopefully allowing nursing judgement to make some of the decision.

Yes, check your policies, check with your pharmacist, and call the MD for clarification if you are unsure.

[NutmeggeRN, BSN]

And always assessing for respiratory depression.

[nursesaysay, LPN]

At my facility we treat them as separate orders. Scheduled meds are scheduled for a reason, PRN meds are there as a back up :)

[ComeTogether, LPN]

As long as it's an appropriate amount in total and V/S are stable I give it, since it's written as two orders.

[miss.amy-sue]

Sperate orders. Unless your facility specifies otherwise. Would reassess your resident after the PRN and before the scheduled. I will sometimes give the scheduled medication a little late to space out the administrations if I think it will be too much.