Rule Book On Narcotic Pain Medication

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:uhoh3:Where is the rule book on giving narcotic pain meds ??? Is it, or is it not OK to give pain meds up to 30 min early if the patient is in need and requests it ?? I have been a nurse with the same hospital for almost 10 years, and suddenly I am not sure if I know the answer or not. CAN ANYONE OUT THERE GIVE ANY INPUT ON THIS SUBJECT ???:uhoh3:

Specializes in Nursing Ed, Ob/GYN, AD, LTC, Rehab.

I have to agree with Kymmi the reason I would not give a q4 med early is because is this was done all day long they would get an extra dose by the end of the day. As well if the pt was in pain again in 3 1/2 hours I would call the MD and ask for the order to be changed or get coverage for break through pain. Now if its a scheduled narc we have a one hour window each way to give this. There is saftey in this because there is no risk at them getting an extra dose. Just lowsy coverage if people arent careful and try to time the doses out right. Neither way is perfect or 100 percent fail proof for pain coverage. Having said that I am surprised you were fired and reported for that. If the pt was stable when you gave I wonder why they went so far. You were obviously looking out for your pt best interest, being pain free. Did you also follow through after and try to get the orders changed? I would investigate this furter and as others say alert your about the situation. Always be overly protective when someone is going after your license, no one is your friend in that situation but yourself and your insurance.

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at our facility, there is no window for prn's, and a 30 minute window for scheduled.

i was taught in school there is never a window for prn's.

but of course, that was in the mid 90's, and regs are always changing.

leslie

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Specializes in Hospice, Med Surg, Long Term.

Personally, I'm not too anal here. The ideal is following the orders, however the policy of your facility will give usually 30 minutes before and after the time ordered as we cannot be in 5 different places at the same time. Sometimes five different patients have meds ordered at the same time. If, after the appropriate pain assessment, I will let the MD know what the assessment shows, how often patient is making requests for the pain meds, etc. and make a recommendation.

The whole idea behind the policy of 30 minutes before and after is because we cannot be a half dozen places at the same time, and surprisingly, this is one thing that administration actually acknowledges with the policy.

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Specializes in CVICU-ICU.

I understand the 30 minute window and not being able to give all meds that are ordered for say 10 am at exactly 10 am....that is not what is being questioned......its giving a prn med 30 minutes early that is in question so in other words if your patient is requesting a prn med that isnt due for another 30 minutes then it shouldnt be given until the 4 hours is up for the reason I've listed above.

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Hi; I'd say q 4 hours is q 4 hrs. If the patient needs more talk to the doctor and get a plan for the patients break through pain. Although, a few times in my 30 year career I have given narcotics early. Rules always get broken. good luck WhiteFlowerRN

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Specializes in Med/surg,Tele,PACU,ER,ICU,LTAC,HH,Neuro.

If I give a PRN narcotic at 3:10, I chart 3:10. I used to chart 3:00, but due to the same reasons posted on this board I don't. I have had nurses use the 30 minute rule , but peer pressure gets them conforming. If you give a narcotic early you should have a full set of v/s, documented supervisor approval, and report it to oncoming HCP. I work nights, this would mean suggest to the doctor a stronger pain med, his pain is poorly releived at night,etc.

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Specializes in icu, er, transplant, case management, ps.

I have a question for those of you who call the doctor when the patient ask for his pain medication a half an hour before it is due. You call the physician and in my experience, it generally takes up to a half an hour to get the doctor on the phone, explain the situation and get the new order. In the mean time, the patient is laying in bed, in pain, waiting for a shot that will be given at the exact time of four hours. Why can't you give the pain medication at three and half hours, call the doctor and get the medication order changed to every 3 to 4 hours, prn?

Woody:balloons:

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Specializes in CVICU-ICU.

Woody....that is actually exactly what I would do.....I do not see a problem giving it a few minutes early one time as long as you are going to address the issue and get the order changed to be valid. The point I am trying to make is not to keep giving it 30 minutes early without getting the order changed....thats where I could see trouble coming because the issue wasnt addressed and a extra dose ended up being given.

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.

I've given 5 or 10 minutes early a few times, that's it. I will then call the doctor and tell them that the pain meds aren't holding. The doctor needs to be aware.

How do you guys handle, say a patient is allowed 1 or 2 percocet. They want to try 1, but then an hour later they want the second one. Do you split the difference on the next dose? For instance, at 0800 they got the first one, then at 0900 they get the second half of their full dose. They can have it every 4 hours, how soon will you give the next dose?

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Specializes in Med/surg,Tele,PACU,ER,ICU,LTAC,HH,Neuro.
I've given 5 or 10 minutes early a few times, that's it. I will then call the doctor and tell them that the pain meds aren't holding. The doctor needs to be aware.

How do you guys handle, say a patient is allowed 1 or 2 percocet. They want to try 1, but then an hour later they want the second one. Do you split the difference on the next dose? For instance, at 0800 they got the first one, then at 0900 they get the second half of their full dose. They can have it every 4 hours, how soon will you give the next dose?

I would give 2 Percocets at 1:00. 4 hours after the second dose.

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Specializes in ICU, ER, EP,.
I understand the 30 minute window and not being able to give all meds that are ordered for say 10 am at exactly 10 am....that is not what is being questioned......its giving a prn med 30 minutes early that is in question so in other words if your patient is requesting a prn med that isnt due for another 30 minutes then it shouldnt be given until the 4 hours is up for the reason I've listed above.

Nope, our policy allows us the 30 minute window for the PRN's, ONCE it is given, than you re-time it from there.

The only way this ficticous "extra" dose occurs is if the doctor wrote, Q6hrs, max 4 doses and it cycled around enough to make 5, well thats a clear med error. Can only give 4, not 5 doses. The physicians are well aware of the 30 minute window. It's not an extra dose, its administering meds according to policy. If there is no max dose written in 24 hrs. you are placing your own restraints on a max dose that doesn't exist and giving yourself too much worry.

I don't recall you stating what your policy said. What MINE states is irrelevant.

If your facility does not grant you this in writing, then your PRN's can only be given up to the minute.

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.
I would give 2 Percocets at 1:00. 4 hours after the second dose.

Now I would give it at 1230, splitting the difference between the two percocets from the morning dose.

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