PRN and e-kits

[ValerieHeath]

Can you give a patient narcotics from a facility emergency kit, when their prn order runs out and there is no refill? I heard 2 different answers to this at work. The pharmacist, says no he could not authorize a med to be dispensed from our kit, w/o a physicians order. Contrary to this a corporate staff said yes it could be dispensed and she has done it her whole nursing career, and it could dispensed without a new order, that the old order was sufficient since it was PRN, even though the order was for a specific number of pills.

[BrandonLPN, LPN]

Its entirely dependent on your facility's ploicies and procedures.

We could tell you what our facility's do, but that would be irrelevant to your situation.

I would get clarification directly from your direct supervisor. Always best to get it directly from the horse's mouth.

[FLArn]

Based solely on the information contained in the question; I would say no as you state that there are no refills. So technically you have no order for the prn medication. I would say you need to call the MD get a new order including the order to use from the ekit until pharmacy fills the order. The procedure for actually removing the med from the kit would depend on your facility policy.

[ClearBlueOctoberSky]

When we have to pull from our narcotic E-Kit, the pharmacy calls the doc to get an order, and then we are given an authorization number.

It is not uncommon for narc scripts to say no refill. You need to call your doc and let them know what is going on with your patient. Is this just occasional pain that the patient had the order for, or is it new pain that you are trying to use an old narc order on?

[HouTx, BSN, MSN, EdD]

State laws vary on this, but if you have reached the end of a PRN script (# doses or time frame), accessing via the E-Kit could be considered 'dispensing' rather than 'administering'. The former is usually restricted to pharmacists or physicians. If this is the case, it would be exceeding the scope of nursing licensure.

[toomuchbaloney]

In order for you, as an RN to administer a drug from that ekit you must have a specific MD order.

For many agencies that order may be a group of 'standing orders' designed to allow rapid palliation of symptoms during the night or on weekends. You must contact the MD for ongoing orders for medications.

[BuckyBadgerRN, ASN, RN]

We can't break into our E-kits (although that's not what we call them) w/o an authorization from the on-call pharmacist. If it requires a C2, and pharmacy doesn't have one on hand, they've been known to get a verbal auth from the MD, but I've only seen that on new admits whose meds haven't arrived from pharmacy yet. With a PRN there's really no excuse not to keep an eye on that and send for them before they're gone, in my opinion, of course