prn med help

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The other day, I was working night shift until 0600. I check on my residents regularly. I had last seen this reservation at 0400. At 0550 he called, stating he wanted his morning pain pill early. He gets tramadol at 0800, but the nurses usually start med pretty early. I offered him tylenol, which he refused. He also has a norco order, but being that early with no food and lethargic, knowing he would get the tramadol at at least 0630 or 0700, I once again offered tylenol in the meantime and repositioned him. His norco order is q 6 hrs prn and Ultram q 4 hrs prn. I have always been taught (8 years) to use non pharmacological means first, and never give a prn that close to a rtn. I followed my gut. Now they are saying I neglected the pt! I was only trying to be safe. They have put me on leave, and it's up to regional if I even get to keep my job. I dont feel I was wrong. The next nurse stated that he always gives this reservation his med btw 0630 and 0700, which proves a prn at 0600 is too close. Am I wrong? Please help.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

First...call your immediately! Ask their advice.

This patient gets PRN Norco and PRN Ultram (tramadol) as well as routine Tramadol (Ultram)?

How did you document?

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To be honest, being the last 10 mind of the shift, I passed it on in report. I didn't give anything to sign out, and they have a problem if we stay late. After I told the pt that the next nurse could give his rtn around 7 he said ok, that's good, and I finished up and left.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

How did this get reported? never mind it Doesn't matter....if this is actively being investigated you probably should not discuss this on the internet. While AN is anonymous it is public and can be searched.

Without documentation to corroborate your story this is going to be tough. From what you have written here you were not wrong. Without documentation there is no proof.

Call your . If you don't have any malpractice get some...although it won't help you know it might in the future.

Take this s a lesson learned...if it isn't documented it never happened. I wish I could have been more encouraging.

((HUGS)) I wish you the best.

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Thanks. I am going to call them. No idea how it was reported though...

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If he had an order for Norco, I would have given the Norco. Not everybody needs food with Norco, and if this resident did, there were probably some crackers somewhere around the place. The patient being drowsy wouldn't bother me much, either ....especially not at 5-6AM (if he were drowsy and his blood pressure read 70/30, that would be a concern!)

The oncoming nurse could have given the scheduled medication on time instead of early of there was concern about the resident getting too much medication ....but if the resident takes these medications regularly, he probably pretty tolerant of them.

I hope you are able to come to some understanding with your management that allows you to keep your job.

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He didn't want the Norco. He wanted "The pill he gets in the morning early" which is the ultram.

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It sounded like you didn't want to give Norco from what you wrote... did the patient refuse it? Now I'm confused.

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Specializes in ICU.

Yes, you were wrong. If it is PRN med that means as needed. He needed it and you decided Tylenol and repositioning? I'm really confused here. If it is PRN what was the reason for not giving it? I'm only in nursing school but when we went through pain, we were taught it is what the patient says it is. It's not about nonpharmalogical interventions. The doctor has already determined that he needs it. It's not up to you to decide. I bet the guy called the charge nurse or someone else in charge stated he was in pain, has a PRN order, and you refused to give it to him. I could give many reasons why you should have given it. It was ultram. It wasn't going to depress his breathing or anything. You would have been ok to give it to him. Plus you did not chart? There are so many things that went wrong in this situation. Pain is the 5th vital sign. It needs to be taken care of. If he had an ultram say a 3am and he wanted it at 550 I could see the issue. It hadn't been 4 hours yet. But you don't mention when his last dose was. I honestly think you were wrong.

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I repositioned him, offered tylenol, as nurses we always go from less to more. The tylenol may work. He specifically asked for his rtn Ultram early.

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Yes, you were wrong. If it is PRN med that means as needed. He needed it and you decided Tylenol and repositioning? I'm really confused here. If it is PRN what was the reason for not giving it? I'm only in nursing school but when we went through pain, we were taught it is what the patient says it is. It's not about nonpharmalogical interventions. The doctor has already determined that he needs it. It's not up to you to decide. I bet the guy called the charge nurse or someone else in charge stated he was in pain, has a PRN order, and you refused to give it to him. I could give many reasons why you should have given it. It was ultram. It wasn't going to depress his breathing or anything. You would have been ok to give it to him. Plus you did not chart? There are so many things that went wrong in this situation. Pain is the 5th vital sign. It needs to be taken care of. If he had an ultram say a 3am and he wanted it at 550 I could see the issue. It hadn't been 4 hours yet. But you don't mention when his last dose was. I honestly think you were wrong.

Heather, when you become a nurse, you will see that you don't always jump to the prn meds, they are usually set up for mild to moderate pain and so forth. You should always offer non pharmacological means prior to meds. Repositioning can work wonders. I do not feel I was wrong in avoiding a potential double dosing. He wanted a ultram, at 0600, the first shift nurse administers this med rtn, due 0800, most give it by 0630 or 0700. If my gut tells me not to do something, I wont. I have never been in this situation before. Most of the time a patient wants a prn after a rtn administration, not right before. I have only been in this facility on wkend for a month. I offered tylenol, it was refused. I reported off to the next nurse to give him the Ultram asap, their policy is 1 hr instead of 30 mins. I ask you heather, would you just give a med, because they ask, without looking at the whole picture?

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Also, I was the charge nurse.

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