My place of work has a MSDS nurse who tries to instruct us on the use of PRN medications. We have a certain resident who has in the past had psychotic episodes, and we have IM ativan to give and once, when the patient was throwing themself on the floor, IM haldol. Other than that, the POA isn't very cooperative and has blocked efforts of routine benzodiazepine and /or antipsychotic administration. Said patient has suspected BPD, but was only on an antidepressant and that didnt manage the mania of course. Well, until recently we got an antipsychotic commonly used to treat BPD and now that it's been a few weeks, the effect is kicking in and things have been going great. Has some bouts of agitaton, and I give prn po ativan to this person and it has worked fine if I catch it soon. My problem is that now the MSDS nurse has given us direct care nurses a side note to give PRN norco to this patient 2x a day. I assess pain in this patient by asking "do you have any pain?" And get a yes or no answer. No probs. Other nurses where I work will just give the med, no question. So by the time I have a shift, said resident will be physically dependent, even if she has no pain. What would you do?? Please note this resident has dementia and can't advocate for self.
Specializes in Gerontology, Med surg, Home Health.
If YOU are the nurse administering the medication, YOU should be the nurse doing the assessment whether it's a pain med or an anxiolytic. I have suggested in the past that the nurse call the MD to get a med scheduled after researching the PRN use. For example, we had a woman who asked for a Vicodin every day at 5pm....I suggested to them they notify the MD and ask him to schedule the med.
I think pain is significantly under treated in LTC especially in the dementia residents. I actually had a so called dementia expert tell me people with dementia don't experience pain. The resident was limping a d she told me it was a nervous tic. I told the nurses to try tylenol twicw a day....the limp and the pained expression was gone.
Use the pain meds if you think they are needed. Perhaps you could ask the MDS nurse how she assessed the resident and what made her think the resident needed Norco.
PS. MSDS=Materials Safety Data Sheet. I think you mean MDS nurse....Minimum Data Set.
Is the MDS nurse trying to justify billing or something? I'm confused as to why she is asking for meds to be given in this manner when she isn't the nurse directly caring for these patients? I'm new to this world, but in my four months at two different LTC facilities, the MDS nurses only concern was that we were documenting properly... never once did one make medication recommendations, especially not asking that you give a PRN narcotic scheduled. That's weird to me. :/
Is the MDS nurse trying to justify billing or something? I'm confused as to why she is asking for meds to be given in this manner when she isn't the nurse directly caring for these patients? I'm new to this world, but in my four months at two different LTC facilities, the MDS nurses only concern was that we were documenting properly... never once did one make medication recommendations, especially not asking that you give a PRN narcotic scheduled. That's weird to me. :/
I think it's weird too. It's especially annoying when I get guff for not giving a prn on one of these residents that they write the "notes" to us about when they did NOT exhibit signs of anxiety/agitation/pain, etc. Because of the behavior episodes in the past, and knowing how fast things got bad, I watch this particular resident like a hawk and I do give prn ativan at the first sx of agitation, per orders. But if there is none (I even ask aides to tell me if pt seems agitated/anxious), I don't! PS: I ama newer nurse too so that's why I'm asking a lot of questions
I think pain is significantly under treated in LTC especially in the dementia residents.
I actually had a so called dementia expert tell me people with dementia don't experience pain.
I've been privileged to receive education on dementia from Maribeth Gallagher, DNP, whose name you may know if you move in dementia circles. I frankly would love to see her get in the same room with whatever idiot said that, because I think it would turn into the steel cage match of the century.
It's like people who claim that babies don't feel pain when they are circumcised. Regardless of your opinion on that particular practice, the claim is absurd on its face. Why are we so willing and even eager to dehumanize the powerless and vulnerable in this country?
I've been privileged to receive education on dementia from Maribeth Gallagher, DNP, whose name you may know if you move in dementia circles. I frankly would love to see her get in the same room with whatever idiot said that, because I think it would turn into the steel cage match of the century.
It's like people who claim that babies don't feel pain when they are circumcised. Regardless of your opinion on that particular practice, the claim is absurd on its face. Why are we so willing and even eager to dehumanize the powerless and vulnerable in this country?
Just so you know, over medicating patients has drawbacks as well. If you see my OP, I was trying to get seasoned nursing professionals opinions on what may well be perceived as the use of "chemical restraints" which is something instructors touch on, among many other things during the course of our nursing education.
Because my question involved OVER use of pain medications and the implications of that. Under medicating doesn't apply in this scenario. Thanks.
Since I was responding to CapeCodMermaid's comment about pain being undertreated in dementia patients (and I quoted same for clarity), perhaps your argument is with her.
The effective treatment of pain in dementia patients could prevent the very overuse of medication as a chemical restraint you're seeking to avoid, since often their agitation and acting out can be attributed to unrelieved pain.
Since I was responding to CapeCodMermaid's comment about pain being undertreated in dementia patients (and I quoted same for clarity), perhaps your argument is with her.
The effective treatment of pain in dementia patients could prevent the very overuse of medication as a chemical restraint you're seeking to avoid, since often their agitation and acting out can be attributed to unrelieved pain.
I wouldn't concern myself with what another nurse posted on my thread. I had a question regarding a scenario with which I wanted a professional opinion on. I most certainly will not seek the advice of a CNA on administering a narcotic, or a healthcare related ethical issue for that matter. I will offer no further comment to your issue with my assertions.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I see that actually everyone agrees with each other...patients need to be carefully assessed before the use of medication as a form of chemical restraint or behavior modification.
I've been privileged to receive education on dementia from Maribeth Gallagher, DNP, whose name you may know if you move in dementia circles. I frankly would love to see her get in the same room with whatever idiot said that, because I think it would turn into the steel cage match of the century.
lifelearningrn, BSN, RN
2,622 Posts
PRN is just that, PRN. If doc wanted it scheduled, it would be scheduled. Why is the nurse asking to give pain meds to a patient not in pain?