PRN and scheduled meds

[sassyann85]

Hi everyone:

Kind of just looking for some reassurance...

So my question is, if a patient has a scheduled med, say Ativan 1 mg PO TID and also

has a PRN order for the same med (Ativan)-let's say Ativan 1 mg PO prn anxiety q 4 hours...then do you have to wait for hours after the scheduled dose to give the PRN dose if requested by the patient? Or are they viewed as 2 separate orders even though they are the same med.

IMO, they are 2 separate orders and while you obviously would want the scheduled med to have a chance to take effect before you give the PRN, you could wait say 2 hours after scheduled dose to give the PRN if pt needs it.

[klone, MSN, RN]

Two separate orders. Give the PRN dose on request, irrespective of when the scheduled dose was given.

[melizerd, ASN, RN]

What the PP said. They don't affect each other so you give the prn as needed and the scheduled dose on time.

[SouthernPoint]

I am sorry, but this is not a simple "Yes, give it" or "No, Don't" answer for me.

If you came to me as a coworker. I would want more info. Is your TID dose timed out already by the Pharmacy? What are the TID time frames. What is the Ativan being used to treat (it's not just for anxiety boys and girls)? How long has the patient been on this med? How are the patients LFT? How often is PRN dose being requested?

I know this sounds like a lot, but this is important information. If your patient is requesting the PRN dose alot. Then the MD needs to address that issue.

But I would personally wait for the scheduled does to be able to peak (which is 2 hours) before I would give a PRN dose. But for me it all boils down to the previous questions I asked.

[pslana]

According to nursing standards of care and practices, TID means q 8 h. or 8, 1600, 0000 ATC for most places. QID q 6 and BID q 12. If we are talking about the scheduled doses. Now TID PRN has no time frame as far as you give that med 3 times a day para re nata. Here is the confusion coming for a lot of nurses when it comes to the same medication scheduled and PRN. We can't deny a pt if the doctor prescribed medication scheduled or PRN. If PRN was a different medication, would you question it? Or just give it? This is the same principle. You can certainly use your nursing judgement and absolutely let the doctor know about your concerns. However, scheduled doses and PRNs are technically speaking two different things just  like Ativan and Tylenol. A lot of times from my experience, we were giving a scheduled dose with a PRN to treat the problem. Then you count time for the next PRN from that moment. But YES! You absolutely can give doses together and of course if you have NTE you need to calculate that and see if you actually could do that. And you always can contact your charge nurse and/or a doctor to get an advise. Hope it helped. 

[MrChicagoRN, RN]

When looking at possibly overlapping times of medications, you need to first look at it's potential effect on the patient. 

You don't want to double up a dose by giving the PRN too close together. How can you say the PRN is needed if you haven't determined if the scheduled med is working or not

Gving Ativan 1mg an hour or two after the scheduled dose is probably fine in a large guy or someone with a heavy tolerance. It's not fine with the little 90lb, or 90 year old who may end up snowed and/or falling.

For the same reason you need to look at what potential effect giving scheduled medication A, followed by PRN medication B, is going to have. You can always give more medicine. You can never take out what's already in the body.

Separate the doses based on best practice for that particular patient.