PRN Narcotics?

[Finallydidit]

Okay... We all know in LTC we have a window of 1 hour before to one hour after to give a sched medication even if it is a narc. ie. sched at 5p can give it anytime between 4 and 6p.

My question is what about PRN narcs. Say they are ordered Q6/hr, can you give them Q5? Is there a window for admin it early?

My thought on this is NO there is no window for giving it early, unless you call and get an order.

Whats your view/policy?

Thanks

[bill4745, RN]

I've always been taught that the window does not allow narcs to be given early. q4 hours means exactly 4 or more hours since the last dose.

[CoffeeRTC, BSN, RN]

If the med isn't holding them for that long you can try a prn tylenol or motrin in between the timing of the narc. If that isn't holding them reevaluate the choice of med.

I will give 1/2 hr early on a prn.

[NurseLoveJoy88, ASN, RN]

I have the same question. A family member wanted me to give a prn but I made sure I gave it at the exact timr due although I wondered if I coukd have givin it an hour early.

[NurseLoveJoy88, ASN, RN]

I have the same question. A family member wanted me to give a prn but I made sure I gave it at the exact timr due although I wondered if I coukd have givin it an hour early.

Sorry for my mis-spellings its hard typing on a cell phone...

[Da_Milk_of_Amnesia, MSN]

Yea i usually dont slide with my narcs...if it's q4H then it's q4H..maybe +/- 10 min or so either way but not usually an hour before..i try and stagger my narc..if i have morphine and I get them comfortable wit it I usually hope (or if i dont i get one a percocet order) so I can stagger the two if need be..or if the percs control it will I just work with those usually 1 for pain 1-5 and 2 tabs for anything >5..works good IMHO

[bill4745, RN]

I have the same question. A family member wanted me to give a prn but I made sure I gave it at the exact timr due although I wondered if I coukd have givin it an hour early.

Sorry for my mis-spellings its hard typing on a cell phone...

It looks like you took your PRN too early!

[Meriwhen, ASN, BSN, MSN, RN]

At the most, I'll give it 10-15 minutes early, especially if I know the patient is on his way to meals/group/to see the doc/whatever and won't be at the med window exactly at the time it's due. But never any earlier than that--I'll bring it to them if I have to.

[FLArn]

I will give a prn a few min. (10-15) early but if the current dose is consistently not holding them until the next dose is due it probably is time to request an increase in dosage or frequency.

[tewdles, RN]

If you are in LTC and you have a patient with PRN opioid orders who is requesting or requiring doses sooner than the allowed interval please call the provider and ask for additional orders. Perhaps the NSAIDs or acetaminophen needs to be scheduled during this the acute phase of this illness or injury. Perhaps another adjuvant needs to be ordered or the dosage of the opioid could be increased. If the patient is on hospice, the case nurse will want to review and adjust the POC if the patient is not comfortable at all times...that is the goal. There should never be a reason that a patient waits for 60 minutes for a PRN pain medication, in any LTC facility.

I really appreciate this question. Pain and symptom control for patients in LTC is a special interest of mine.

[Bubbles_RN]

I will give narcs within a 1/2 window on either side for prns. However if I find they are needing a fair bit of prn medication......or if the timing isn't working for them I usually re-assess thier medications.

Maybe they need a change in narc or do they need an NSAID or something like gabepentin if they are having nerve pain.

[november17, ASN, RN]

if it's q4H then it's q4H..maybe +/- 10 min or so either way but not usually an hour before..

Yea that's basically the policy where I work and also my own personal policy.