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PRN times in psych

Posted

Hi everyone!

Just wondering what everyone's take on this was. Lately, I have been seeing PRN orders that read, for example, Ativan 0.5 mg PO TID PRN. Some nurses say this means the PRN can be given every 8 hours. Others say as long as it is 3 doses in a day, that is fine (ie-if the pt requests the med for anxiety at 7am then is anxious and wants it again at 10am, that is fine but the pt is informed they will have 1 more dose left for the remainder of the day).

How do you all handle this? Often times if the pt is reminded that maybe they want to 'save' some PRNS in case they need them later, they will say something like "well I get more anxious during the day and am ok at night..."

How do you handle this?

verene, MSN

Specializes in mental health / psychiatic nursing.

If I'm ever unclear on the orders I'll call office for the prescribing doctor and ask which interpretation they were intending when the order was written.

marshmallowstar, BSN, RN

Specializes in Peds, Neuro Surg, Trauma, Psych. Has 5 years experience.

I would talk to your prescriber about writing clearer orders. We sometimes go through this with new residents till we talk with them. Our orders would be written q4 hours not to exceed 3 times a day.

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

I would talk to your prescriber about writing clearer orders. We sometimes go through this with new residents till we talk with them. Our orders would be written q4 hours not to exceed 3 times a day.

Agreed.

However, if a Decision must be made before a Clearer order is Recived, a Rule of Thumb is Four Hours between Doses.

The facility I worked at outlined the dosing schedule for orders like this in our policies. TID dosing for an adult unit of patients was 8,2,8. If the doc wanted it q8hrs then he ordered it that way. I think most places outline this in policies and procedures.

Meriwhen, ASN, BSN, RN

Specializes in Psych ICU, addictions.

IMO a lot depends on the medication itself and the situation. Generally I'll try to stick to time intervals--that is, TID would mean about 6-8 hours doses. But if I see a patient getting agitated or escalating, I'd go ahead and give a second dose of PRN sooner than that. I'd also let his provider know that I'm doing that because they may want to reevaluate the current orders.

clockwood

Specializes in Pediatrics, Psych. Has 5 years experience.

This is a great question and a perfect example of the need to clarify an order. The fact that YOU alone are unsure how to interpret the order is reason enough to call the provider for clarification. Don't ever "guess" what the order means, as you may be practicing outside of your scope if you "misinterpret" an ambiguous order. It is your job to clarify.

That we know the order is being interpreted in various ways by various individuals, it is especially important for you to clarify. As another commenter mentioned, it would be wise to read your facility specific policy and procedures manual to find the definition for "TID" (whether your facility uses it to mean three times daily or every 8 hours). Once you know this information, make sure the provider is on the same page. :)