raymori

There are many ways to get around this nursing-wise, however it does not meet TJC rules. I'm not sure you understand the scope of the situation or understand the question. Nurses can work around many things, but it seems to now be undermining nursing judgement and making physician's go through busy work. If a nurse puts a note in but doesn't give the medication exactly as ordered, then the nurse may be "prescribing," such as giving 2mg morphine when ordered is 4mg. I think you are looking at things from a staff nurse position, but TJC will look at things from an organizational position. The point of TJC is not what you mention. I'm not sure what nurse gives dilaudid for 1-2/10 pain, but no nurse that I know does that. If that is the point for TJC, then that would be scary and I would throw nursing judgement out the window as well. TJC is trying to make things with less errors, but I think it undermines nursing judgement and assessment.

Thank you, I think the first bullet answered a lot of the question: 1. That the medication order is written in a manner that supports deferring to patient preference when: a. Requesting a lesser potent medication. (Potency should be established with an evidence based tool i.e. morphine equivalents). b. Requesting a lesser prescribed dose in a range order. c. Requesting a less intrusive route of administration if both routes are prescribed by the provider. I guess it is ok to administer a lesser dose (if in a range order) or less potent medication if needed. Nursing judgement will come into play and they may question if nurses are "prescribing" rather than using judgement. I'm not sure why TJC is cracking down on the verbiage, but it seems just like busy work rather than anything evidence-based to back up this crackdown on prn analgesics. Our practice will not really change, but only the way the order is written.

It's almost time for TJC to come by and I'm wondering how your organization places prn orders for analgesics. Right now I'm hearing things that make nursing judgement obsolete because it may appear to TJC nurses are "prescribing" medication in certain situations. How does your organization deal with such issues: Currently we need to have prn analgesic orders with a pain rating, such as "Tylenol 650mg Q4H PO prn for mild pain; Norco 5-325mg Q4H PO prn for moderate pain." We technically cannot give Tylenol if a pt rates their pain 5/10, but they ask for the Tylenol and states Tylenol works really well for their pain. We must call the provider, ask to change the verbiage in the order, and then it's okay. This sounds totally like a waste of time and undermines nursing judgement. Another example is we have a lethargic pt post-op and is NPO and requiring morphine IVP and the order states 4mg morphine IVP q3H for moderate or severe pain. The nurse only wants to give 2mg morphine IVP d/t the lethargy, but that may be seen as "prescribing." I'm not sure how we will deal with prophylactic analgesics, such as before physical therapy or major dressing changes. Maybe there needs to be something that states "for mild pain or prior to PT" in the order. We need the whole organization on the same page and I'm just wondering if there are any organizations with a good system right now.