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.

Specializes in Care Coordination, MDS, med-surg, Peds.

Another thing to consider... if he ALWAYS requests the rtn pain med early, how about checking with Dr to change the routine pain med to 0600? Then he wouldn't have to ask.

Seems to me, his pain is poorly controlled through the night, he wakes up in pain at a level he knows tylenol won't touch. Maybe he needs long acting pain meds like durgagesic/fentanyl patch or similar to maintain a consistant pain control level.

Look at the WHOLE picture and assess why he is always asking for pain meds. OP didn't state his diagnoses, but I am sure there will be some clues there. Best wishes with management.

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Specializes in NICU, PICU, Transport, L&D, Hospice.

The way your employer is treating this is too harsh.

You should have given him the prn tramadol per request and MD order.

The oncoming shift would have to determine if they would administer the routine medication after having received your report and assessing the patient.

I agree that if he often wakes early with pain it would make sense to reschedule his a.m. routine med to accomodate that individual schedule.

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Specializes in ICU.

Trust me, I do see the big picture here. What I don't think you are seeing in the big picture and what your employer is trying to get you to see is you didn't take care of your patient. I think you read way too much into the situation and didn't take care of his pain. It was a PRN med and tramadol at that. I know people are going to point out it's a control now, but it's not like morphine and diludid that depress respirations. I'm actually quite knowledgeable in this area. I know you see nursing student and think I don't know what I am talking about but I do have a little knowledge here. When a doctor writes for a PRN medication he anticipates that doses could be close together. Your patient would have been fine and he would not have overdosed. By not giving him the med, you essentially ignored him. The repositioning was not effective this time. I would sit down and discuss this with my employer and see what can be done to save your job.

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Specializes in Pediatrics, Emergency, Trauma.
Another thing to consider... if he ALWAYS requests the rtn pain med early, how about checking with Dr to change the routine pain med to 0600? Then he wouldn't have to ask.

Seems to me, his pain is poorly controlled through the night, he wakes up in pain at a level he knows tylenol won't touch. Maybe he needs long acting pain meds like durgagesic/fentanyl patch or similar to maintain a consistant pain control level.

Look at the WHOLE picture and assess why he is always asking for pain meds. OP didn't state his diagnoses, but I am sure there will be some clues there. Best wishes with management.

THIS.

Moving forward, it's best to remedy the situation effectively, especially when there is a PRN available, even if the PRN med is a scheduled med, and then pass in report to see if they can change the time of administration; that will help the pt far more than not medicating the pt, especially one with chronic pain; repositioning is not going to be as effective or a lower tier med such as Tylenol. :no:

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Specializes in Cardiac.

I agree with previous posters.. I would have given the PRN tramadol. Even if the scheduled was given on time it would still be at least an hour away and the pt would be in continued pain, which in turn would probably make the pain worse and therefore harder to control. Chasing pain is no fun. Also, in my opinion, he just wanted Tramadol. Some pts have Morphine and Diluadid ordered q1 or q2... If he had been tolerating the med well in the past, just give the freaking med. Just my opinion..

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I think what the op did was fine. I would have done the same. I would have told the patient that they would be getting the med in 30 mins and that they could have Tylenol in the meantime. I never give med that is both pen and scheduled within less than four hours of each other unless instructed otherwise. And within the last ten minutes of my shift I've already handed over my keys to the next nurse anyway.

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Specializes in Critical Care.
I think what the op did was fine. I would have done the same. I would have told the patient that they would be getting the med in 30 mins and that they could have Tylenol in the meantime. I never give med that is both pen and scheduled within less than four hours of each other unless instructed otherwise. And within the last ten minutes of my shift I've already handed over my keys to the next nurse anyway.

Why 4 hours?

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I was wondering how much time should you spend with nonpharmalogical interventions? It does kind of sound like torture just thinking of ways to make people who are in pain wait and try different positions until we feel like nothing else works.

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Specializes in Short Term/Skilled.
I think what the op did was fine. I would have done the same. I would have told the patient that they would be getting the med in 30 mins and that they could have Tylenol in the meantime. I never give med that is both pen and scheduled within less than four hours of each other unless instructed otherwise. And within the last ten minutes of my shift I've already handed over my keys to the next nurse anyway.

The whole point of PRN pain meds in addition to scheduled, is for breakthrough pain. You would refuse a prn pain med because a scheduled med is due 3.5 hours later? Doesn't that defeat the purpose of the PRN med?

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Specializes in ER.

I am not sure of the dosage the patient was prescribed. But tramadol can be 25mg,50 or 100mg. If it was 25-50 mg I wouldn't have had a problem given the medication. It was clear that the patient was in pain and repositioning it didn't help. Even if it was 100mg I would have told day shift that the prn was given and that she might want to give his routine a little later (within the window of hour after). Unless the patients vital signs reflected his lethargy I would have given the medication. To be honest it's hard to say what anyone would do without actually being there. As for the work...they are blowing this way out of portion.

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