Percocet PRN

MunoRN, RN · Jul 10, 2011

It depends on your facility policy.

By the policy where I work which allows for more flexibility within the boundaries set by the order, yes you could give 1 every 3 hours, as long as you don't exceed the maximum dose per amount of time ordered, your facility's policy may differ and may be less flexible.

ChristineWV · Jul 10, 2011

Thanks for the reply. That's how it was at the hospital that I trained at, but I wanted to do that today at the patient's request at the new facility that I'm working at and an RN jumped all over me...said the doctor's orders were for 2 tablets q6h. I told her that the patient requested it as 1 tab q3h and she said that it would be exceeded the orders...tried to reason that I wouldn't go over the prescribed dosage but she asked "But what if he wants 2 tablets next time?". I indicated that I would not give him 2 tablets the next time after we had started to stagger...she said I would then be denying him what the doctor ordered. Couldn't quite figure it out after that. Just wondering if others have done this.

Guest321574 · Jul 10, 2011

How do you sign it as given though (we have paper MAR's though, not sure how it would work for electronic)?

I wouldn't esp not with a narc. My personal policy is stick to the order precisely as written, you can always ask for a new order if you feel it is necessary. I've seen doctors write orders like Trazodone 50mg 1 or 2 tabs qhs. Ummm no, do you want the pt to have 50 or 100, its not up to me to make that call. If it is really that flexible than the doc should write something to the effect of "may repeat in x amt of time if in effective, not to exceed...etc."

danh3190 · Jul 10, 2011

Another problem is what happens when you hand the patient off to another nurse? Isn't it just easier to ask the MD to change the order?

MunoRN, RN · Jul 10, 2011

Another problem is what happens when you hand the patient off to another nurse? Isn't it just easier to ask the MD to change the order?

?

Change the order to what?

tyvin, BSN, RN · Jul 10, 2011

?
Change the order to what?

:confused:

deemalt, BSN, RN · Jul 10, 2011

We have parameters at my facility that will specify 1 tab percocet for pain levels 4-6 (or mild pain) and two for 6-10 (or severe pain). This would be a good suggestion if changing the order. Not such a great idea to mess around with giving 1 q 3 hours. Technically, you are prescribing by not administering as ordered.

MunoRN, RN · Jul 10, 2011

We have parameters at my facility that will specify 1 tab percocet for pain levels 4-6 (or mild pain) and two for 6-10 (or severe pain). This would be a good suggestion if changing the order. Not such a great idea to mess around with giving 1 q 3 hours. Technically, you are prescribing by not administering as ordered.

Do you find that every patient's 6/10 pain requires the same level control as everyone else's? If so you have surprisingly consistent patients.

It's a range order, giving 1 tab q 3hrs is still giving it as ordered. It is not prescribing to follow a range order. My wife has a bottle of Norco sitting here on the counter that says "take 1-2 tablets as needed every 4 hours". Being of reasonable intelligence, she understands that this means if she takes 1 and it's not effective, she can take another, as long as she doesn't exceed 2 tablets in a 4 hour period. I she prescribing her own Norco by doing this? Why is it that Nurses claim range orders are too complex for us to follow when it's something the general public has no problem understanding with their home meds? Am I the only one that finds that fact extremely embarrassing?

Karl Farmer · Jul 10, 2011

Your policy cannot alter a phsyician order. If it says '2 q 6' PRN, and you give '1 q 3' PRN, you are practicing medicine wihout a license, administering medication against the order on the label, and other violations that might include narcotic charges. You cannot be too careful. Get the order changed to read '1 q 3' PRN, or better yet '1 or 2', q whatever hour (s) based on a standard pain scale of 1-10 (or whatever your employer uses), and document the pain scale on the med sheet as well the dose you gave. That leaves nothing to misinterpretation.

danh3190 · Jul 10, 2011

?
Change the order to what?

to 1 tab q3 PRN as the patient requested

deemalt, BSN, RN · Jul 10, 2011

Do you find that every patient's 6/10 pain requires the same level control as everyone else's? If so you have surprisingly consistent patients.
It's a range order, giving 1 tab q 3hrs is still giving it as ordered. It is not prescribing to follow a range order. My wife has a bottle of Norco sitting here on the counter that says "take 1-2 tablets as needed every 4 hours". Being of reasonable intelligence, she understands that this means if she takes 1 and it's not effective, she can take another, as long as she doesn't exceed 2 tablets in a 4 hour period. I she prescribing her own Norco by doing this? Why is it that Nurses claim range orders are too complex for us to follow when it's something the general public has no problem understanding with their home meds? Am I the only one that finds that fact extremely embarrassing?

Well, you have some good points here. The problem is we are talking about narcotics. I know that we have such strict parameters at my facility because of past incidences of drug diverting by RNs. The orders are not too complex, they just leave room for someone to get in trouble in the worst case scenario.

As far as the numerical pain rating system, we find out what our patient's tolerable level is and go from there. This way we can get a personal baseline which may vary from "0 pain" or "6/10 pain" as being tolerable. We have to have some way of knowing where our patient's personal pain tolerance lies and then issue meds accordingly.

A prescription of 1-2 tablets would not fly in a hospital situation. It all boils down to covering butts. What people do at home with their own bottles is different. Technically, your wife could take six pills if she wanted because she is self administering. In a hospital, the RN is administering and it needs to be documented and orders followed.