Quote from Hygiene Queen
I have seen Ativan ordered just TID PRN.
I still try to space them appropriately.
If the pt takes 1mg and then wants another just an hour later, I encourage other coping skills until I clarify with the doc.
I can see this type of order being used for Tums but I dislike when I see it for something like Ativan.
I just try to use some common sense but I have gotten this changed before especially when pts want it too close together.
I mean, as written it sounds like you could give them 3mg in 3 hours... though I don't know anyone who would do that.
I agree with you, OP.
First, I adore your "handle"...Hygeine Queen totally rocks! :0) Second, thank you for your input-very much appreciated!
This is how I see a T.I.D order as well; "technically", & probably legally, (as long as the client is not sedated, has appropriate vital signs and SaO2, & you document as much...INCLUDING THE REASON for needing SO MUCH Ativan SO CLOSE together--a client experiencing extreme agitation/anxiety attack, with corresponding VS & client statements/actions documented to prove such), you probably COULD GIVE three doses of Ativan in three hours and be covered, as long as you gave NO MORE until 21 hours later!
Hopefully, in a client that acutely anxious or agitated, an RN/LONG would have a physician involved long before dose #3 of 2Mg Ativan was considered; & would be suggesting alternative meds, such as IM Geodon, or perhaps ODT Zydis, etc...but, we're talking legalities and "what ifs" here, not perfect or even best example...
Of course we all know that this would not, except perhaps in EXTREMELY rare cases, be the "reasonable and prudent nurse's course of action", but still...
I completely agree with you; IF such a PRN order was used with Ativan or other sedating med, it would be risky, and I too would first off get an order rewrite/clarification, and change it to at the very least contain written PARAMETERS!
Now, in the case of the Tums (my original T.I.D order example) I feel it WOULD be appropriate....that's the thing with T.I.D vs. Q8h...they each have a "place"in PRN order writing, from a physician-standpoint, and order following, from a nursing standpoint, and I do NOT BELIEVE THEY ARE interchangeable, to a great degree, as they do not mean the same thing!
Anyhow, again, I very much appreciate your input! Anyone else like to share their perspective?