Proper PRN Administration

calivianya, BSN, RN · Sep 12, 2015

The worst part of having a job where you have to deal with people? Dealing with people.

Stuff like this is why I prefer to work with patients that have a tube down their throats. The only advice I can offer if this behavior bothers you is to find a different job... preferably one where patients are unconscious/unresponsive. I think that is the only setting where you can truly use judgment about PRNs. Otherwise, if the patients say they need their PRNs and you don't give them, you are just setting yourself up for a really difficult shift and buying yourself an appointment with your manager over patient complaints about you.

With the whole reimbursement/satisfaction thing going on, we are encouraged not to use our judgment and just give the patients whatever they want. Nursing judgment with PRNs isn't welcome anymore.

iluvivt, BSN, RN · Sep 12, 2015

Each prn order should have the reason for which it may be administered or what sign or symptom you are trying to control or alleviate. Since symptoms are subjective such as pain and anxiety, it it best to believe your patients as long as it safe to administer it. Some nurses want to judge and say I do not think my patient is in pain because they are talking on the phone, eating, or using the internet or whatever the nurse thinks they cannot do while in pain.

Signs are objective such as you can hear the patient coughing and can see what they cough up or you can hear hyperactive bowel sounds or a heart murmur for a few examples.

In your case if you do not hear the patient cough and lungs are clear, etc you do not have to medicate the patient. The problem may be that other nurses are medicating to just keep the patient quite and I admit I have often just given the medication if I know it will not hurt the patient and just chart the patient states he has been coughing and then my assessment. It is best if you are all on the same page especially in your type of setting, but that may be difficult to achieve! That may be part of the problem here and then you are placed in a bind. In terms of the patient and his anxiety I would just believe him and medicate him if he stated he is experiencing it.

Elixirs are alcohol based and some cough suppressants have codeine in them. What is the medication..is it an expectorant or suppressant?

blondy2061h, MSN, RN · Sep 12, 2015

I would be asking the prescriber to d/c the robitussin on the man with no cough obsessing over it.

ElizabethGreenwood · Sep 12, 2015

Suppressant...as for anxiety, that's not my concern as much although we're Supposedly encouraged to redirect them whenever possible and use "our skills" unless the or is too far agitated.

allnurses Guide · Sep 12, 2015

So I am a recently hired LVN at a lower level of care psych facility. I have this patient who hallucinates and will say things like oh I was in the shower for 15 mins and I stop breathing I died for 15 mins. So he does this kind of thing often and there's no telling him otherwise. He's like a 42 yr old with a 5 he old mentality. So he Thinks he's very sick and has a cough and when the MD was in the facility a couple of days ago he gave an order for PRN cough drops and Robitussin. So the AM nurse gave the PRNs which are Q2Â° and Q4Â°...the pt was back at the station within 45 asking for the cough syrup again. The RN in charge told me it's because they think it has alcohol in the syrup. The pt tried t ask me for it after the AM nurse left and it was a struggle to explain to him that the 4 hours weren't up yet and to rest his throat and relax in his room. He's Very talkative! After so redirection he said I was right he didn't need his PRN anymore. I kept an eye out all night as did my staff of 5 cnas...not one of us saw or heard him cough our entire shift but he was relentless about getting the Robitussin. I explained it's As Needed for Cough per the order and he threatened to call Patients Rights on me and to call our Md doctor which he can't. The RN had told me to use my judgement in giving him the PRNs. With psych I'm finding it difficult because they love to threatened and accuse us. I offered the cough drop and the or finally agreed to take just the cough drop. Another resident has been assessed by our RNs and the PAs and does Not have asthma but still received an order for an inhaler. He was trying to abuse it to get high. They changed his inhaler and with a little redirection he forgets that he supposedly can't breathe. How can I make the right decision with these PRNs in psych?? These two pts are used to nurses who'll give them anything they ask for without using any actual judgement. When I'm there they get so upset. Oh you want an Ativan even though you're just chillin, laughing with staff and don't appear the Least bit agitated? Suuuure why not. It's frustrating!

First of all if you are working in the united States there must be a phone on the unit that the patients have access to and they can call anyone they want. It's one of their rights so yes they can call their doctor. If they ask for the doctors number you cannot refuse them tis. If they ask for assistance in dialing you have to do that as well. AS far as the PRN goes I never used the words as needed with the patients just would say something like every 4 hours and we had these little clock faces that we would put the hands on the time and tell when the clock on the wall matched they could have more. You have to be really creative with with psych patients especially if you a mixing in a a population of true psych with addicts/alcoholics detoxing and addiction medicine and psych are two different things.

Hppy

cherliang1 · Nov 24, 2016

One can say the whole psychiatric field is grey. I was asked by a few colleagues who asked me for my rationale for administering a PRN milk of magnesia (MOM). They claimed that their BM book says this PT went yesterday. First off, this BM book is subjective because we ask the patient for this information. This patient approached staff for "the powder **** that makes me ****." I used to work on this unit for years and this patient never ever asks for PRNs. This PT is further complicated because he has a severely resected bowel. It was about 1500 hours when he asked for this PRN and I gave it to him. My first rationale is that I believe this patient. My second rationale was perhaps the book is fallible, after all the unit had a patient in the last year die from a perforated bowel from an impaction. My third rationale, milk of magnesia is rather benign and won't hurt the patient. My fourth rationale is that the PT is on severely constipating medications like Clozaril. I guess the other nurses on the unit have their own philosophy against the way I practice my psychiatric nursing. However, it is ultimately my license and I can live with giving someone diarrhea versus someone dying of an impaction because I believed a book over the patient. The night shift charge nurse told me I could hurt the patient by giving him the MOM when he doesn't need it. She told me he could have horrible runs and that could lead to a bad outcome. I have never heard of someone dying of milk of magnesia overdose in my 5 years of nursing and 2 years of nursing school. Of course I was unable to articulate my rationales at the time either.

caliotter3 · Nov 24, 2016

As long as you work with colleagues who are going to continue to medicate for convenience, you are going to run into trouble if you insist on going by the book. You can choose to fight this issue every time the patient says he wants something for a cough, but does not cough, or you can just give in and go with the other nurses' flow, or you can look for a new job. Not much of a choice, but consider that you could go to a new job where you just run into a similar choice.