Timeliness of PRN's

[noc4senuf]

This has never come up before as most nurses/TMA's give out a PRN when asked for unless it is too soon and then an explaination is given as to why the resident can not have it.

A resident asked for her Ativan at 7:30AM, again at 9:00AM and still again at 10:30AM. At that time, the manager on the floor also heard and instructed the TMA to get it to the resident ASAP. It was also noted that the rest of her 8AM meds were not given until this time too, including Procardia that was ordered at 7:30AM "before breakfast". The resident and family made a formal complaint in writing to the NHA.

When confronted, the TMA made comment to the fact the even when the licensed nurses pass meds the do not always get done within the exact timeframe. We have decided to not dwell on the other meds but, just the PRN. All of my managers are in agreement that a PRN should be given within 30 minutes of a request. Is this what everyone else feels also??

[TheCommuter, BSN, RN]

If it's a PRN pain medication, the state in which I practice requires the issue to be addressed within 10 minutes. If it is anything other than a pain med, then 30 minutes sounds reasonable.

[CapeCodMermaid, RN]

I think you need to be very careful when writing time frames. If your policy says 10 minutes and you are in the middle of an emergency and the patient has to wait 15 minutes, you could get cited. And, of course, you have to consider the patient. We have a patient who asks for pain medicine every 30 minutes whether she has just received it or not. Anyone walking down the hall would think we were neglecting her requests but in reality, she is an addict and we have a care plan about giving her medications.

[debRN0417]

CapeCodMermaid, you are right. Most of the time it's a policy that does you in. Your policy says you are going to do this or that within a specific time frame, and when you don't you are not following your policy....however, I feel a facility should never be cited for just not following their policy. I don't think that is fair. There needs to be some type of outcome associated with it rather than just saying that you didn't follow the policy for this or that. As far as pain, and pain management, you have to be careful as that can lead to a pretty bad outcome during the survey process, (potential for harm or actual harm). If a Resident requests pain medication and it is not administered "timely", the resident/family can allege neglect or abuse...also we as caregivers certainly do not want our residents to suffer at all, if we can help it.

I should add that if a resident is requesting PRN medication before the next dose is due, then we need to assess as to the reason why...maybe they need more medication, different medication, put on scheduled times rather than PRN, stronger meds...we need to make sure that we notify the physician of this within a reasonable time frame and not let go on for days and days before we act on it. Make sure it is documented and care planned if someone is one of those folks that ask again right after you have given it, or "forget" they got it, or just like to tell their family that no one ever gives their meds when they ask...I hate to say that but we all know it happens. Document and care plan!

[noc4senuf]

Thanks for all the feedback. But, I did not state there was a policy. I prefer to not have written policies for every little thing unless a reg states we need to have one as they will usually cite if not followed to a "t".

As an update, the TMA was let go. This was just the final thing in a long string of issues that surrounded this person.

[southernbeegirl, BSN, RN]

prn means when the pt needs it, not when the nurse gets a chance to give it