Range orders

The last hospital I worked at didn't allow range orders,the docs had to write two orders-Pecocet 1 q 4hrs for moderate pain and then a second-Percocet 2 q 4hrs for severe pain.This way the pt could decide what they wanted,of course there were always the ones who wanted 1 and two hrs later asked for another 2 since there were two orders.that could cause a problem.

...There is no reason to call a doc because the pt wants LESS pain meds - and that is considered acceptable at my facility...

I disagree...

You are assuming all the nurses taking care of that pt are doing as thorough (and the same) of an assessment as you...

You have now taken away the constant (dosage) (see other posters about doing away with range orders) - You have essentially made your own range order, as you see fit...

Well, you go home in 8-12 hours, and someone else may have a different idea for this pt...

if the order is 2 mg dilaudid q 2 hours, and you give the pt 1 mg every 2 hours, the doc absolutely needs to know...not telling him leads to inconsistent dosage administration...perhaps the nurse following you may be a new grad, and gives 2 mg, because that's what the order says...

The doc needs to know so he can maybe tweak the regimen...

And of course calling him at 0220 would be lame...We all get that...Letting him know can mean leaving a note on the chart...

...Say the order is for 10 mg oxycodone Q4 prn. If the pt asks for just 5mg, you can give 5mg, but if they want more before the 4 hours is up, then you have to call. The order is for 10 q4, not 5 Q2. As I said, that is considered normal procedure for us.

I've been doing this 12+ years... NEVER, has going outside the prescribed parameters (under or over) been the standard at any facility I've worked...

The reason to give the prescribed dose is exemplified exactly in your above example...You did your own thing by underdosing, now, at 0220, you have to make the call...

I am with you as far as the pt having the final say. If the guy wants only 5 mg of the oxy, great, I'll give it. BUT, let's say he finally got up the courage to tell you at 0220, that 10 mg is too much (after 3 days of receiving 10 mg)...Is halving his dose at 0220 the best plan, as he is likely not to have effective pain relief, since he's used to 10 mg. THIS is why it's important to let the doc know (in the AM). Maybe vicodin would give him less side effects, and still provide adequate pain relief.

I'm not advocating against nursing judgement. But keep the doc in the loop with any changes you have made...It will make for better outcomes for your patients...

We are not allowed range orders for anything... I have no problem giving less pain meds than ordered. ..

As I stated above, giving less is making your own range, thereby contradicting your policy...

...I would find out why the patient was refusing the lopressor or requesting only 1/2 the dose and explain to the patient the risks behind the refusal and then I would notify the doctor that patient refused because some other treatment might be needed to manage the B/P however if the patient requests only 1/2 the amount of pain med and that controls the pain then no harm done.

This supports my reasoning...

You absoultely keep the doc in the loop w/ a BP med not working properly "because some other treatment might be needed to manage the B/P"

Wouldn't you afford the doc the same shared info when it comes to pain control??

Substitute "pain" for BP