PRN meds

[mom-wife-nurse]

Ok, this is mainly geared towards LTC nurses. If you have pt ask you for a PRN and it is too soon for them to have it, do you take it to them when they're eligible to have it? I always tell my pts that I can't just bring them a PRN. They need to tell me what is wrong and I will medicate as ordered. Some nurses I've worked with will just take them the PRN when they are eligible for it if they've already asked. What do you all do?

[mom-wife-nurse]

If you're talking about pain meds, Munro makes a good point, we need to assess our patients pain before they come asking. The idea of pain medication is to prevent pain from progressing rather than just control break through pain. Pain is subjective, it's important to note if the medication regimen they're on is sufficient, especially if they come chasing you for it. Just because a medication is prescribed, doesn't mean it will work for that particular patient, or if they've been on it long enough, they may need to switch due to tolerance buildup. Too often, there is a stigma with pain meds as it relates addiction/dependence, and this can interfere with proper pain control.

Not necessarily pain meds, mainly other meds....phenergan, mucinex, etc.

[anon456, BSN, RN]

I have had this same question.... Alert & oriented Patient asks for cough syrup at 1am but can't have it until 3am. At 3am patient is asleep with no noted coughing. Do you wake the patient up to ask if they still want cough med?

I have never given cough medicine to a patient so I don't know . . . but if it was a pain med and the patient is not due for some time, I call the MD and tell them. I also look for changes in VS, posture, and facial expression. The MD can often prescribe a 1x dose of something else, and it alerts the MD that the current orders is not working. I work in peds, and we rarely have drug-seeking patients. The rules might be different in the adult world.

[Here.I.Stand, BSN, RN]

I have had this same question.... Alert & oriented Patient asks for cough syrup at 1am but can't have it until 3am. At 3am patient is asleep with no noted coughing. Do you wake the patient up to ask if they still want cough med?

For cough syrup I won't wake someone up--they can't sleep through coughing. However people can fall asleep while in pain. So what I do if someone is alert and oriented is ask them--"if you fall asleep, do you want me to wake you up when it's time?" Some will welcome uninterrupted sleep, while others (sometimes rightfully) are more concerned that when they wake up their pain will be completely out of control and want to take their meds as soon as they can.

[HappyWife77, BSN, RN]

Give them their medicine when they can have it.

[Sam J.]

Oftentimes a physician orders a med to be give PRN, even if he/she knows it's actually given (and needed) routinely. In fact, if anyone is 'in pain', why would the pain itself be fleeting (PRN) rather than require routine medication?

[Sam J.]

I had a resident who demanded her vicodin when night shift came on. Sometimes she wouldn't even wait for report to end. According to PM shift, she never demanded it from them. As many times as I asked her what was wrong, she would stare at me with the most defiant, hateful look and say nothing. So no assessment of a need, I left the room. The call light went back on. Spanish stand-off. I never was able to get her doctor to change the order to routine. Apparently, he was just fine with things as they were. The PM shift nurses laughed at me, the CNAs complained, and even her neighbors said I should give it to her just "because".

Much is awfully wrong in this post about tone, lack of compassion, supposition, and racial degradation. Sad, and scary post.

[Sam J.]

Give them their medicine when they can have it.

Even before they have to ask for it.

[morte, LPN, LVN]

1) you don't know cali's ethnicity.

2) legally we have to have a reason to give med.

Much is awfully wrong in this post about tone, lack of compassion, supposition, and racial degradation. Sad, and scary post.

[caliotter3]

1) you don't know cali's ethnicity.

2) legally we have to have a reason to give med.

Thank you morte. I bent over backwards for that resident, taking time and effort that should and could have been used where better needed. Other nurses even vocalized that they were taking the "easy way out" instead of doing what was appropriate. See no reason to sugar coat the telling for delicate sensibilities.

[suanna]

I had a resident who demanded her vicodin when night shift came on. Sometimes she wouldn't even wait for report to end. According to PM shift, she never demanded it from them. As many times as I asked her what was wrong, she would stare at me with the most defiant, hateful look and say nothing. So no assessment of a need, I left the room. The call light went back on. Spanish stand-off. I never was able to get her doctor to change the order to routine. Apparently, he was just fine with things as they were. The PM shift nurses laughed at me, the CNAs complained, and even her neighbors said I should give it to her just "because".

The patient knows thier meds, what they are for, when they are due. The patient has to feel like they are being required to beg, or jump through silly hoops to prove they are entitled to the medication thier doctor ordered for them to manage thier pain. How many "pain assessment" quizzes and alternative therapy attempts did you have to go through the last time your doctor prescribed Vicodin for pain for you at home after a surgery or injury. You hurt-you knew what would fix that-you took a pill. Patients want the same degree of control.

[morte, LPN, LVN]

suanna, the patient wasn't participating in the assessment, refused to verbalize the "why".......

The patient knows thier meds, what they are for, when they are due. The patient has to feel like they are being required to beg, or jump through silly hoops to prove they are entitled to the medication thier doctor ordered for them to manage thier pain. How many "pain assessment" quizzes and alternative therapy attempts did you have to go through the last time your doctor prescribed Vicodin for pain for you at home after a surgery or injury. You hurt-you knew what would fix that-you took a pill. Patients want the same degree of control.

[Sam J.]

1) you don't know cali's ethnicity.

2) legally we have to have a reason to give med.

The question is- what does ethnicity have to do with any patient that wants a pain med or anything else, whether the nurse feels or doesn't feel there is a legal reason to give that med?