PRN Pain medication

[heatherw3128]

I'm a new LPN and just started working in behavioral health. My primary job at my facility is to dispense medication, but I'm having difficulty with the PRN pain medications. Many of the patients want multiple pain medications together (Ibuprofen& Tylenol, Ultram & Oxycodone) ect. The facility has no policy on whether they should be given together or how long to wait between administration. Everyone I ask gives me a different answer and some nurses will give the medications together and some will not. So far I have been refusing to give them together because I feel that I would rather be safe than sorry, but I am not sure what the correct way is. Any advice would be appreciated.

[MunoRN, RN]

There is no single correct rule since it all depends on what the prescribers intentions were. This can often be defined by policy, since then the prescriber is aware of how the order will be interpreted and can alter that if needed. So without knowing how the prescriber intended the order to be understood, or any policy that sets a common understanding, there is no right answer.

I wouldn't be all that concerned about giving tylenol and an opiate together, since that's actually a really good way managing pain (percocet, vicoden, etc are all opiate/tylenol combinations). Ultram in theory has fairly minimal adverse effects in terms of CNS depression since it is a opioid pain receptor specific synthetic, although it still has some adverse/euphoric effects. It's mainly combining true opiates or opiates with other CNS depressing drugs that should cause potential concern.

[morte, LPN, LVN]

I think an additional issue on the OP's unit, is that, it is a Behavioral Health unit....by giving all at once does this not go against developing coping mechanisms other than drug dependence?

There is no single correct rule since it all depends on what the prescribers intentions were. This can often be defined by policy, since then the prescriber is aware of how the order will be interpreted and can alter that if needed. So without knowing how the prescriber intended the order to be understood, or any policy that sets a common understanding, there is no right answer.

I wouldn't be all that concerned about giving tylenol and an opiate together, since that's actually a really good way managing pain (percocet, vicoden, etc are all opiate/tylenol combinations). Ultram in theory has fairly minimal adverse effects in terms of CNS depression since it is a opioid pain receptor specific synthetic, although it still has some adverse/euphoric effects. It's mainly combining true opiates or opiates with other CNS depressing drugs that should cause potential concern.

[toomuchbaloney]

If your department and nursing management cannot provide you with clear guidance you must seek the opinion of the prescribing provider. The provider's intent must be evident in your administration of the medications and documentation.