Scheduled PRN

[BunnyBunnyBSNRN, ASN, BSN]

We have a student who has a "PRN" anti-anxiety medication.  The father wants it given every day at 11a since he gives it at home in the morning around 7a.  I have asked repeatedly for a change to the order to have it scheduled.  The father keeps saying he is "going to talk to the doctor".  I've tried calling the doctor's office, but their answer to me was "only the parent can request a change" without even hearing me out or saying they would pass on the message to the doctor.

At this point, kiddo comes in everyday at 11a and says, "I feel anxious.  I need my medicine."

What would you do?

[k1p1ssk, BSN, RN]

What the heck is it? Is it a supplement or an FDA approved med? If it is FDA approved, is it a controlled substance (I.e. lorazepam, clonazepam)? This is dicey territory....

I think I might contact the doctor's office again, but make it clear that you are not asking for a change. Tell the receptionist that you would like the prescriber to know that the kid is taking it at least 2x per day, before noon, and you are looking for CLARIFICATION of the order, as the family is asking you to schedule it, but their orders do not allow you to do so. 

Another option, is to bypass the receptionist, who may be working under certain, very strict parameters... When you call the provider's office is there a "Press 8 if you are a physician or calling from a physician's office" prompt?

I almost always use this and get directly to a nurse or MA who are almost always more understanding and willing to help.

[BunnyBunnyBSNRN, ASN, BSN]

k1p1ssk said:

What the heck is it? Is it a supplement or an FDA approved med? If it is FDA approved, is it a controlled substance (I.e. lorazepam, clonazepam)? This is dicey territory....

Hydroxyzine

I think I might contact the doctor's office again, but make it clear that you are not asking for a change. Tell the receptionist that you would like the prescriber to know that the kid is taking it at least 2x per day, before noon, and you are looking for CLARIFICATION of the order, as the family is asking you to schedule it, but their orders do not allow you to do so. 

Tried yesterday and got voicemail.  Sigh.

Another option, is to bypass the receptionist, who may be working under certain, very strict parameters... When you call the provider's office is there a "Press 8 if you are a physician or calling from a physician's office" prompt?

Unfortunately, there is not that prompt.

I almost always use this and get directly to a nurse or MA who are almost always more understanding and willing to help.

I absolutely use this option when available.

 

[k1p1ssk, BSN, RN]

Well, I guess I would just follow the PRN order to a "T", until you get clarification. 

Another question, though: Does the prescription label say something different than your order? Like, does it say "take 1 tablet every 4 hours as needed for anxiety" or does it say "1 tablet twice per day"? 

I do see that the typical pediatric dose of hydroxyzine for anxiety is 50-100mg per day, given in divided doses, so if the kid is taking 50mg at 7am and another 50mg at 11, then you're at least within those safety limits.

Regardless, until it is scheduled, I would be documenting the heck out of these visits. I think I would be taking vitals every visit. I might even go so far as to make the student wait for 15minutes or return in 30 for reassessment of efficacy... That alone might be enough of an annoyance to the kid that they pressure their parents to seek a new order...

[beachynurse, ASN, BSN]

k1p1ssk said:

Well, I guess I would just follow the PRN order to a "T", until you get clarification. 

Another question, though: Does the prescription label say something different than your order? Like, does it say "take 1 tablet every 4 hours as needed for anxiety" or does it say "1 tablet twice per day"? 

I do see that the typical pediatric dose of hydroxyzine for anxiety is 50-100mg per day, given in divided doses, so if the kid is taking 50mg at 7am and another 50mg at 11, then you're at least within those safety limits.

Regardless, until it is scheduled, I would be documenting the heck out of these visits. I think I would be taking vitals every visit. I might even go so far as to make the student wait for 15minutes or return in 30 for reassessment of efficacy... That alone might be enough of an annoyance to the kid that they pressure their parents to seek a new order...

I like how you think! I would probably do the same thing. Kids today are on so much anxiety medication that I worry about them. But if the order is PRN, then that's what it is. I would not be calling the student to take the med daily. The only way that happens is if the order says so, and the dosage is safe. 

If you feel that the order is unsafe, or you need clarification on an order, we have the right to hold the order until we can ensure that the order is correct, and if not, until we receive the correct order. Once you tell the parents that you are concerned for the safety of the student, and will hold the med until you get clarification, you'll see just how fast the parents will help you get the information from the MD.