Ok, here we go...just think, this COULD be fun!! :0)
As a 15 year-practicing, highly experienced RN, with a background in a multitude of specialty areas, I have come across a nurse manager who has a belief about PRN order interpretation, which is well, interesting to say the least.
Believe it or not, the Nurse Practice Act in my state, nor the BRN, are able to give me a satisfactory answer on this. Despite having graduated from an accredited school of nursing, with a BSN, I DID graduate 15 YEARS ago...thus, my textbooks (all of which I HAVE KEPT) ARE somewhat outdated, so I am looking for a current answer re: this question (which I do PROMISE TO GET TO), eventually! (ha). Sorry! ; 0)
Ok, here is THE Queston: Please explain your understanding of the acronym "T.I.D." when used in a PRN order, VERSUS, "Q8h" when used in a PRN order...why are they the same/why/how do they differ?
Let me begin by saying this:
1) My understanding is that there are TWO OPTIONS (T.I.D. & Q8h) for a REASON. In other words...if they meant the SAME THING, the two DIFFERENT WAYS OF PRESCRIBING WOULD NOT EXIST.
2) I was taught and have always followed (remember, only in the case of PRNs!) the concept that T.I.D. = "three times daily" & is generally the order of choice for specific cases where meds which cannot harm if given on a non-timed/ non-"well-spaced" time frame.
Example? Tums. Silly example, but it works for illustrative purposes. (& for the sake of the example, because we are nurses and I just know someone will bring this up...this is a healthy, non cardiac, non-hypercalcemic, 20 year-old who gets occasional heartburn due to overeating a bit too often)...
How I would handle this dosing with a "T.I.D" order?: GIVE ONE @ initial request. Second assessment after one hour, client states some, but minimal, response and tells me, "@ home, I usually take three or for before it works", and I WILL give the other two.
Now, this client has had three Tums in two hours, is feeling fine, and even if she wasn't, would get no further Tums for 24 hours. Instead, I'd call and get an order for something else if my assessment didn't show other untoward signs requiring further testing/etc...
Ok..new client/new scenario:
3) "Q8h"...Ativan 2Mg PO. Client can get dose #1 @ initial request at 0500. Then, they want another dose at 1500. Great. Give it...it's been greater than 8 hours and thus, is allowed. Next, they ask for Ativan at 2100. Answer is, "Sorry Mr. Jones...you've only had your last dose six hours ago, so it's a bit too soon. I will check with you at 11 pm (2300), & if you are still anxious, I'll be happy to give it to you then!
4) The order is WRITTEN Q8h BECAUSE we don't KNOW WHEN MR. JONES is going to become anxious, but we DO KNOW (by the way he's written the order) that our MD does not feel comfortable giving him his Benzo closer than every EIGHT HOURS.
Now give me all of your opinions/scenarios, or straight up bottom line answers! I can WAIT TO SEE what other RNs and LPNs think! Have at it guys...it'll help my unit out a lot to see where the CONSENSUS lies.
