Reasonable time frame for prn medication to be given?

[nicegirl2]

When a patient asks for a prn medication lomotil how long is reasonable time to wait for the med to be given, the nurse stated she would be there shortly, then stated she will get to her when she gets to her No emegencies going on.... Also said when she finishes her med passing.... 2 part question time frame and how she spoke to the family handling the situation. Ty. It was given an hour and half later pt. had abd pain and loose stools that entire time.

[mtmkjr, BSN]

I'm with you peachtreenurse

How hard is it to grab a couple Immodiums as soon as the patient asks? It will make the patient and family happy, and avoid big complaints later. I would like to avoid cleaning up a mess and making families angry enough to escalate their complaints up the food chain!

It takes a minute of my time and saves a lot of grief later.

Patients and families often do not think of anything beyond their own needs nowadays, some truly do not care if somebody's trying to die, they just want Mama to be taken care of.

Sometime it's easier to just go along, to get along,

Well that is the problem right there.

The family probably thinks it should take just one minute. They just don't know...

[mtmkjr, BSN]

We ALL know how HARD nurses work and how caring and sincere; yet, an outpouring of support for the inability to administer lo-motil including giving verbal explanation and excuse as to why it was not possible, is surprising to me. There is ALWAYS some reason for the commission of an act or it's omission, and several points of view to consider, none of which are brought up before unrelated accounts rather than investigatory questions and potential solutions...

1. diagnosis / how, if related, hospital acquired

2. dr. order / prn whether q 1, 2, 4, 6 etc. follow some pattern, related to a routine med pass

(Also, has something happened to anticipating the needs of the patient? A good rule of thumb I found was according to report and, or days post-op, chronic pain, febrile status or any number of NECESSARY reasons to RECEIVE medication is to ascertain potential need within the expected time frame, by observing and questioning the patient and referring to MAR) In the long-run it ends up being more expedient for documentation and sequentiality, as well as patient comfort and care with less random buzzer calls and interruption.)

3. dr. order/ prn, for LOOSE STOOLS, on THIS PATIENT that I feel it was important enough to hospitalize and order for...!; NOT prn for loose stools, unless something more important comes up.

I can go on about the dangers of dehydration, potential for electrolyte imbalance, intestinal bleed, parenteral fluid replacement, weakness, potential of falls, other complications...but prefer to just stop with " in the time it takes to explain to patient, family member, or physician it is easier and less stressful to give the med as timely as HUMANLY and HUMANELY possible"

This is how I like to practice nursing in the ideal world, and in my job, I am actually able to give care this way on the good days. However it is not unusual to be in a situation where things are falling apart around me. At that point, I've given up completely on anticipating the needs of all my patients, and I am limited to responding to actual problems needing my immediate attention.

[Miss.LeoRN]

One aspect of this I haven't seen questioned is... prn what? Pen doesn't just mean " I get it when I ask for it". There's usually a stipulation added to prn, like prn bid, prn tide, prn Q4, prn Q8.... Even prn per loose stool up to # of doses. When was the patients last previous dose and what exactly was the order? How many does had they received prior? Those are all equally important questions.

[Pepper The Cat, BSN, RN]

We have a doctor that refuses to order Imodium or lomitil unless the diarrhea has been ongoing for several days. And c diff has to be ruled out first. His theory is that we load the pt yep on Imodium, then the pt complains of constipation so we treat that. And then treat again for diarrhea.

[Daisy4RN]

Not all nurses are overworked or as totally devoted as you expressed.

I do know that communication is key. The nurse needed to explain that she needed to get a doctor's order for Lomotil, the Lomotil wasn't due til _____, she had to assess someone who had fallen or ___________ whatever emergency the OP had not seen and did not know about, etc.

Communication can stave off a lot of problems.

And please don't expect the pt to understand or care that nurses are spread too thin or understand about prioritizing. All they really know is that their loved one is in pain and seems to be forgotten or ignored.

I agree that communication is important. We do not know what communication transpired between this patient/family and nurse.

Most nurses who work on med/surg, step down, ICU etc do work their behinds off (at least in my experience) and do have either potential life-threatening and/or life threatening and/or urgent issues that come up daily that would slow down a prn of any sort.

I do expect patient's and families to understand that they are not the only patient the nurse has and that it is impossible to be in 2 (or more!) places at the same time. There is no reason that grown adults (who are not confused etc) should not be able to understand this. I have been a patient in the hospital (even before I became a nurse) and fully understood this, I have had family (with very serious) illness' in the hospital and understood this. I do not think it is too much to ask!

[Daisy4RN]

IBS is also painful. That picture is not funny IMHO. It shows how little you seem to care.

I think the poster was just making the point that urgent/life threatening issues will ALWAYS come first and should.

[cyc0sys]

I think the poster was just making the point that urgent/life threatening issues will ALWAYS come first and should.

Lesson learned: Ask for PRN pain meds first. They have a 1 hour window.

Final outcome= Patient got meds, were all safe, and didn't die.

That's how I measure the level of 'care' I provide.

Measure yours however you want.

[Daisy4RN]

Lesson learned: Ask for PRN pain meds first. They have a 1 hour window.

Final outcome= Patient got meds, were all safe, and didn't die.

That's how I measure the level of 'care' I provide.

Measure yours however you want.

I am not sure you understood my comment but I was defending your post/agreeing with you. (Or maybe I don't understand yours, hard to tell sometimes)

[Guest219794]

IBS is also painful. That picture is not funny IMHO. It shows how little you seem to care.

Interesting take on that post. Nothing in it indicated that the poster does not care.

What field of nursing are you in?

Maybe it gives you a different perspective,

[EDNURSE20, BSN]

Lesson learned: Ask for PRN pain meds first. They have a 1 hour window.

Final outcome= Patient got meds, were all safe, and didn't die.

That's how I measure the level of 'care' I provide.

Measure yours however you want.

Wait! You allow one hour to give prn pain meds? That's probably one prn med I would give pretty quickly, no way would I wait an hour.

[Ddestiny, BSN, RN]

I'm with you peachtreenurse

How hard is it to grab a couple Immodiums as soon as the patient asks? It will make the patient and family happy, and avoid big complaints later. I would like to avoid cleaning up a mess and making families angry enough to escalate their complaints up the food chain!

It takes a minute of my time and saves a lot of grief later.

Patients and families often do not think of anything beyond their own needs nowadays, some truly do not care if somebody's trying to die, they just want Mama to be taken care of.

Sometime it's easier to just go along, to get along,

There are just sometimes that it's not an option. I find it common that just the act of the nursing walking in the hall tends to solicit requests -- even when you're walking to go to a different/more urgent task.

When I get a request I make all attempts to fulfill it right away. I want my patients to know I'm on their side, and I don't want to get distracted by something else and forget. If that's not an option then 99% of the time I will communicate an estimated time, because I am someone that values communication. But there are circumstances where things...just...happen. There are just too many examples to give. Have you ever compared those stories with co-workers of when a patient (confused or not) thought you were ignoring them when really you were running around like crazy? I have.

Do we know if that was the case here? Nope. Maybe they do have a lazy nurse. Maybe she forgot and didn't want to admit it. Maybe she didn't really care. Maybe something came up and she actually apologized profusely when she arrived to the room. Maybe she needed to get an order and that point either wasn't communicated or wasn't understood. You can't tell from the description. And patients and families don't tend to know the circumstances unless we overstep our boundaries...or the family member peeks out the door and sees the next room full of people and a crash cart or someone on the floor.

I'm sure you already know this, I just had to respond to the bolded text.

And to the OP... not everything is an emergency, but neither is diarrhea. Is it painful, uncomfortable, problematic? Absolutely. But there are some things that need to come before pain, "can you refresh my water," etc. Sometimes it's hard to know where your request is in the "triage line". I don't know from the post if the setting in this example was LTC, Acute care or what but a lot of urgent things don't involve bells and whistles. Hopefully you'll have plenty of positive experiences to outweigh the inevitable times when you/your loved one must wait your turn.

[Guest219794]

Wait! You allow one hour to give prn pain meds? That's probably one prn med I would give pretty quickly, no way would I wait an hour.

Actually, there are plenty of ways you might wait an hour.