Published Jul 2, 2005
I'm a new nurse in orientation on a med-surg floor. Yesterday was my third day. In the evening a pt. requested a pain med and my preceptor told me to go draw it up and give it while she was charting. When I looked at the MAR i noticed that the med was ordered for every 3 hours but had last been given 2 1/2 hours ago. My preceptor said it was okay to give it because of the "30 minutes before or 30 minutes after" med rule. I did not think this applied to narcotics. Am I wrong?
It may or may not be wrong, but I use that as adequate justification to give narcs early if I think my patient needs it.
But then, I always follow up with the doc about redressing adequate pain management.
The hospital/facility has a written nursing policy/procedure on administering meds that defines the time span in which you can give an ordered med. For many years, that was universally 30" before to 30" after the time ordered by the physician (because, when you're doing a med pass, you can't give 25 different patients 9 AM meds all at precisely 9 AM ...) Nowadays, I notice many hospitals are going to a standard of 1 hour before to 1 hour after the ordered time (which seems v. scary to me). Unless the hospital policy specifically states that the time window doesn't apply to narcotics (which I have never seen, BTW), you are in the clear.
I have often given pain prns at the "2-1/2 hour" point you describe (at the first moment it is legal to give it again) -- but, if I can see that is becoming a pattern for that patient (rather than a one-time occurrence), I also follow up with the physician about the patient not getting sufficient relief from the meds as ordered.
exactly... if the pt. requires the narc early for 1 dose, i've no problem giving it 30 mins. early... but if the pt. is chronically seeking the med early, i would ask the MD to reassess the pain med and/or dosage...
having said that, i once had a pt. tell me that he always asked for his meds early because it usually took the nurse at least 20 minutes to get the med to him after he asked (so if it was due at 1500h, he'd ask at 1430h so he could have it by 1500h in case the nurse couldn't get to it right away)...
barefootlady, ADN, RN
Your instructor gave you the general rule most facilities and nurses follow. You need to read the policy of the facility regarding narcotic administration. Make sure to report any and all pain meds given to the patients to the nurse who will be taking over for you. That nurse needs to know the patient requested pain med early. Agree with other posters, if patient asks for pain med early x 3, I call the doctor and relate the circumstances. Some patients do realize to ask a little earlier than med is due because nurse needs to go through several steps prior to giving the med.
You sound like a student who is taking an interest in learning the right way to do things, that is good to read. Good luck . :balloons:
I hate prn pain meds, with the exception of truley occassional pain, they are the exact wrong way to administer pain meds. The patient should be given them q4, q6, or whatever, but not prn. By the time they feel pain (or major pain as the case is), it takes twice as much medication to get them back to baseline vs. a constant blood conentration.
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