QID PRN, HELP!

caliotter3 · Feb 15, 2021

AFAIK, you space it out every six hours. If there is otherwise a maximum number of doses in 24 hrs, that will be specified. If you have any questions about what is meant in an order, you should call the MD who prescribed the medication for clarification.

amoLucia · Feb 15, 2021

cali - what's AFAIK? I don't know all the abbreviations. TYIA

Re your answer - I don't know that I'd hold it out for a 6 hr interval. No more than 4 doses in 24 hrs - OK. But if I truly believed someone to be in need of a med BEFORE 6 hrs, I'd admin it at 4 hrs at the earliest. No earlier. My goal is to keep the pt comf as best as poss.

I just tried to do the reasonable thing. (But TBH, I hate those kind of iffy orders.)

chare · Feb 15, 2021

Two (three, four) times a day isn't necessarily the same as every 12 (8, 6) hours.

At my facility, medications ordered wo (three, four) times a day are scheduled during the typical awake hours. For example, a medication ordered three times a day would be scheduled at 0800, 1400, and 2100. If the physician wants the medication to be administered at even intervals around the clock he or she would need to order them every 12 (8, 6) hours.

ETA: I agree with caliotter3, if there is any question you should contact the ordering physician for clarification.

chare · Feb 15, 2021

1 hour ago, amoLucia said:

cali - what's AFAIK ...

[...]

As far as I know.

amoLucia · Feb 15, 2021

chare - TY

MunoRN, RN · Feb 16, 2021

By the commonly used definition of QID (vs q 6 hours or 4 times daily), "QID PRN" is a non-sensical order.

BID, TID, and QID are not the same as q 12hrs, q 8hrs, or q 6hrs. QID means that the medication is to be given at the defined administration times for QID medications (0800, 1200, 1600, 2100 for instance). Q 6 hours on the other hand means the medication is given 6 hours apart based on when the first or previous dose was given.

Technically a "QID PRN" order would mean you would give it only at those designated times, and only if the PRN indication was present.

I did have a physician who wrote orders this way: "metoprolol succinate 50mg BID PRN SBP >90 mmHg". When I asked for clarification, he said he wanted it given at 9am and 9pm, not at any other time, but to only give it if their SBP was greater than 90. I pointed out it would make more sense to write it as "metoprolol succinate 50mg BID, hold for SBP <90 mmHg". He was insistent that his way made more sense, but also complained that for some reason every nurse asked him to clarify the order.

marienm, RN, CCRN · Feb 18, 2021

My hospital has standardized med times (example: BID = 09 and 21; TID = 09, 17, 21). If parameters need to be written (like Muno's example of holding a drug if a BP or HR is out of range), they are included with the administration instructions. We also have Q(interval) times, so Q4h usually falls on the 04/08/12/etc schedule. These are also nice and clear.

Maybe it's coincidence, but our PRN orders for SIGNS (like hypertension or fever) tend to say "Q8hours PRN for fever" or "Q6hours PRN for SBP>170." Generally, I feel this is a clear way to indicate when the med should be given. 1)Is the BP>170? 2)has it been at least 6 hours since the last dose? 2a)are there no other changes in condition that change your approach? 3)if 'yes' to all of the above, give the med! OP, I don't know if you can get the order changed but this is how I would want it written.

However, our PRN meds for SYMPTOMS (such as anxiety or itching) are often ordered as just "PRN TID" and we are in the same quandary as the OP...can I give the patient PRN Xanax at 09 when they just had it at 05? (Obviously assuming they are not obtunded or other changes.) These meds are most frequently home meds that have been reordered and I have no reason to want to disrupt what the patient normally does but I also need to look like I'm following the rules! I wonder whether this type of order will eventually be eliminated the same way that MsO4 isn't an allowed abbreviation for morphine any more. It seems like it is too open to interpretation, at least for inpatient settings.

sleepwalker, MSN, NP · Feb 19, 2021

I did have a physician who wrote orders this way: "metoprolol succinate 50mg BID PRN SBP >90 mmHg". When I asked for clarification, he said he wanted it given at 9am and 9pm, not at any other time, but to only give it if their SBP was greater than 90.

This Physician is a moron and is going to end up killing someone writing orders that way

JKL33 · Feb 20, 2021

I guess I'm weird, regarding the above order I don't know how else it could be interpreted other than exactly the way the physician described.

Check the b/p at BID times (09//2100). If the b/p meets the parameter, give the med. If it doesn't, don't.

What other way would so many other nurses interpret this?

JKL33 · Feb 20, 2021

On 2/18/2021 at 9:54 PM, sleepwalker said:

This Physician is a moron and is going to end up killing someone writing orders that way

That seems like a bit of an exaggeration, doesn't it? I'm struggling here--what other way would the order be interpreted than exactly what the physician described?

Seems pretty straightforward: Check the b/p at BID times (09//2100). If it meets the parameter, give the med. If it doesn't, don't.

Not sure why so many would be confused by that idea; the order as written describes precisely what was intended...there really isn't any ambiguity to it.

sleepwalker, MSN, NP · Feb 20, 2021

5 hours ago, JKL33 said:

That seems like a bit of an exaggeration, doesn't it? I'm struggling here--what other way would the order be interpreted than exactly what the physician described?

Seems pretty straightforward: Check the b/p at BID times (09//2100). If it meets the parameter, give the med. If it doesn't, don't.

Not sure why so many would be confused by that idea; the order as written describes precisely what was intended...there really isn't any ambiguity to it.

1) the order is for metoprolol succinate...that's an extended release med to be given daily NOT twice a day...nice way to cause an overdose. Metoprolol Tartrate is administered to BID to maintain therapeutic dosing level

2) The order is written as PRN...why? If the med is to be given properly the order should be "metoprolol succinate 50mg PO daily for SBP >90 mmHG (which seems a little low to me but whatever)