scheduled meds and PRN dose orders in nursing home

[hospicemom]

example: clonazepam is scheduled TID AND Q4 hours PRN. Question: do you take these as two seperate orders or as one order. To clarify.... If the scheduled dose is at noon and in one hour they are still not managed can you give the PRN dose at that time or do you need to wait until 4 pm to give it? There are many different opinions on this. I believe it is two seperate orders and we should be able to give the PRN dose one hour later. Other nurses believe the PRN can not be given until the 4pm mark to make sure there are 4 hours between doses. Asking for some insight and other opinions on this. Thanks!

[elkpark]

Like most everything else in nursing, your facility/employer should have a specific, written policy -- in many places, it's common that prns can be given >2 hours before or after a scheduled dose of the same medication, for example. Those kind of policies are there to protect you, so I would encourage you to ask your supervisors and get a firm answer that applies to everyone. Or ask the ordering physician to write an order specifying.

It is just asking for trouble to leave this kind of decision up to each, individual nurse's judgment.

[Whispera, MSN, RN]

it would depend on what the dosage is of both the scheduled and prns doses are too, as to whether it's safe or not....

[morte, LPN, LVN]

without a doc's order i would be aiming at the four hour interval...after all, at on hour the med is just kicking in....if this is happening around the am dose, you may want to consider spreading out the scheduled doses to more nearly Q8......which maybe what the doc intended anyway

[leslie :-D]

without a doc's order i would be aiming at the four hour interval...after all, at on hour the med is just kicking in....if this is happening around the am dose, you may want to consider spreading out the scheduled doses to more nearly Q8......which maybe what the doc intended anyway

i would hope the tid order would be written as q8h, which would ensure atc administration and steady levels.

and i agree about checking your p&p manual about prn's.

leslie

[marachne]

Abosolutely agree w/what everyone has said, and here's a few other things to think about: besides dose, what is the action (as in time to effect/half-life) of the med? For example, po tab morphine is going to take longer and stay in the system longer than IV morphine, so dosing timing will vary. Also, where is the patient in terms of their needs? If pain/anxiety/SOB, what ever is being tx is labile, you may be using the PRN more frequently. If there is a clear escalation of symptom, or tolerance, you're going to want to do whatever you need to keep on top of it (boney mets?) If we're talking incident pain (pain with movement, like when cleaning up or changing position or dressing change), you want to plan those PRNs to coincide with need.

Another thing that hopefully is being looked at is the PRN useage -- if there is a consistent pattern of high PRN useage, it's time to adjust the scheduled dose to more frequent and/or higher dose (or other agent/route!)

[morte, LPN, LVN]

i would hope the tid order would be written as q8h, which would ensure atc administration and steady levels.

and i agree about checking your p&p manual about prn's.

leslie

yeah, but leslie, you and i are rational persons.......in LTC the P+P tells you what TID is for that institution....with some exceptions....and nurses dont alwasy look for the exceptions.......years ago had an issue were i worked, a doc scripted for oxycontin/mscontin.....BID and the nurse made it 9A and 5P....when i changed it to Q12 she changed it back and said the doc wrote BID and that was 9/5.......i did get a chance to ask that doc about it and it was changed!.....but this is the mind set that you are dealing with....