HELP!!!question about prn med

Nurses Medications

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The order reads: Roxanol 20mg/ml give q2hrs PRN et qevening. I gave a dose at 1930 which I signed off as PRN, my med aide was to give the evening dose at 9pm. She is refusing to give because it hasn't been 2 hours. I was under the impression that you can still give the scheduled dose and not have to wait 2 hours for the PRN dose (to treat them like 2 seperate orders)? Am I right or wrong??

Roxanol is a POWERFUL drug.It appears you gave a dose for breakthrough pain @ 1930. The administration of the scheduled dose @ 2100 certainly needs to be re-scheduled to accommodate the 2 hour time frame.

What's missing here is.. what was the patients pain level, vital signs, etc.

Administering the scheduled dose @ 2130, assuming pain was persisting and the vital were stable.. is the answer.

This particular resident in on hospice and dying of cancer, she is always in pain that she rates a "7". She has been recieving the PRN Roxanol pretty frequently for the past few weeks. She explains to me that she never gets pain relief. Vitals are stable. Some nurses I work with say I'm right, and some say I'm wrong. Huge debate at work right now.

Specializes in Emergency.

I think in this situation the most important point is that the patient needs to have her pain control reevaluated. That being said, you need to include your scheduled dose in the decision to give a PRN dose. Giving doses at 1930 and 2100 when the PRN is q2 seems like no big deal, but extrapolate to the next dose. Would you give that at 2130 since that is 2 hours post the last PRN? I would hope not anyhow.

In my experience this type of order covers a scenario where the patient is not requiring PRN analgesia at that specific time in order to give a dose prior to bed to facilitate comfort and allow a better, less disrupted sleep.

Maybe this patient would benefit from a q4 scheduled order with hourly breakthrough doses. Maybe there needs to be another drug added to the mix. I don't know, I don't have all the information but I think (and from your post it appears you agree) that a constant pain level of 7/10 in a palliative patient is not acceptable.

Specializes in Acute Care, Rehab, Palliative.

I would still give it a scheduled. I would take the PRN and the scheduled dose as separate orders.If the position was reversed I would give it. Suppose you gave the scheduled dose @2100 and she asked for breakthrough at 2230. I would still give it.

As a side note, if she is needing frequent breakthrough then she needs her scheduled pain meds reassessed.

I reread it, and would have given it. Though I wouldn't necessarily give the PRN 20 minutes after the routine, I try not to completely snow anybody. But yes, I consider PRNs and routines separate orders. Maybe ask for an MD clarification so the pt receives more consistent pain management.

If her pain is always a 7, maybe she needs some adjunct therapy.

Specializes in LTC, med/surg, hospice.

As a hospice nurse, I would ask for a better med order. We have roxanol ordered as often as Every 15 minutes PRN.

As to the current order, I would not hold the scheduled dose if the patient is having unrelieved pain

They are two separate orders, IMO.

The order reads: Roxanol 20mg/ml give q2hrs PRN et qevening. I gave a dose at 1930 which I signed off as PRN, my med aide was to give the evening dose at 9pm. She is refusing to give because it hasn't been 2 hours. I was under the impression that you can still give the scheduled dose and not have to wait 2 hours for the PRN dose (to treat them like 2 seperate orders)? Am I right or wrong??

Well, maybe I'm just tired and sleep deprived, but the first thing I noticed about that order is there is no dose.

"roxanol 20 mg/ml" is not a dose. It's simply the concentration of the medication in the liquid.

If the doctor wants the dose to be 20mg (a pretty high dose, but not unheard of), he needs to write "roxanol 20mg/ml. give 20mg (1 ml) SL q 2hrs PRN"

Or, if the dose is 10 mg, it should be written: "roxanol 20mg/ml. give 10mg (0.5 ml)" and so on.

It DOES NOT matter who is right or wrong here.

What matters is this patient is not getting ADEQUATE pain control.

Call a team conference including pharmacy, the physician , ethics committee, etc.

Please get the patient comfortable.

Specializes in LTC, Memory loss, PDN.

i usually instruct med aides not to hold the routine dose since the routine regimen wasn't adequate to begin with

when it comes to roxanol or sublingual morphine i will administer myself anyway

if i have any doubts in a situation like this i call the hospice service and often times orders are changed or dosages adjusted

I would probably give the scheduled dose.

(Unless patient appears like they may not tolerate it well. Nursing judgement y'all.)

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