Tylenol ordered for pain.

Wigglerwilli · Apr 30, 2015

I agree with above! Those docs can be rude! But some are awesome . I think you're spot on, shake him off. He probably was deflecting stress upon you or he is just a pompous jerk!

gouranga · May 1, 2015

You are correct. The order for Tylenol you had was for pain. Of course you know Tylenol can be effective for a fever, but the doctor did not order it that way.
If I recall, The Joint Commission is the governing body that cracked down on giving medication such as Tylenol and Motrin, only within the guidelines written. You had no orders for fever so you correctly called the doctor.

I've been searching the joint commission's site to find information about orders. It's kind of a hard site to navigate. I haven't found anything significant yet.

gouranga · May 1, 2015

with the exception of one doctor, all the doctor's at our LTC facility use a standing order of Tylenol 650mg for mild to moderate pain 1-5/10 or temp greater than 100 degrees. This order covers the bases for us and the doctors. That one doct will write 2 different orders.

That would have made my life so much easier.

gouranga · May 1, 2015

The order wasn't for fever, it was for 1-2/10 pain. While the med can be used for fever, without an order for it (protocol or otherwise), you technically could get in trouble for administering the med.

That's what I thought. And if I'd given a med without an order that he didn't approve of, I'm sure he would lose no sleep over writing me up. I just want clear orders, is that so much to ask??

gouranga · May 1, 2015

While Tylenol can be used for pain and fever, it must be ordered for both. If the order was strictly Tylenol for pain, the OP did not have an order to give the Tylenol for fever. If she gave it without the order specifically stating to give for fever, she would have been practicing medicine without a license and could get in big trouble. There is a huge push for proper indications on PRN medications and for these PRN medications to only be given with the specified indications.
OP, you did the right thing based on the orders you had at the time. Don't let this doctor get to you. Perhaps you can bring the issue up to your manager as a need for management to remind the doctor's of the need of proper indications for PRN medications.

Thanks so much.

vintagemother, BSN, CNA, LVN, RN · May 1, 2015

Pyelonephritis hurts, at least a little bit... enough to give Tylenol. I'd have reassessed pain. Surely they were hurting a LITTLE bit, enough to give the Tylenol. You can notify the doctor after you've treated the "pain"/fever.

This ^^ to cover your orifice.

gouranga · May 1, 2015

Pyelonephritis hurts, at least a little bit... enough to give Tylenol. I'd have reassessed pain. Surely they were hurting a LITTLE bit, enough to give the Tylenol. You can notify the doctor after you've treated the "pain"/fever.

I eventually realized I could have just given it and documented it was for pain. However, I did give her Toradol shortly before and thought it would look bad pumping all of these pain medications into the pt without giving them time to work.

SarahJ08 · May 1, 2015

This is why I won't be a nurse for the rest of my life. It is preposterous to me that anyone outside of the hospital can take Tylenol for whatever reason. But in the hands of licensed healthcare professionals, it's considered practicing medicine. What a joke. I would have given it without thinking twice about weather or not it was ordered just for pain. I also hope you work day shift and didn't wake a sleeping doc to give the Tylenol for fever. Also, is nursing judgement not a thing anymore?

gouranga · May 1, 2015

This is why I won't be a nurse for the rest of my life. It is preposterous to me that anyone outside of the hospital can take Tylenol for whatever reason. But in the hands of licensed healthcare professionals, it's considered practicing medicine. What a joke. I would have given it without thinking twice about weather or not it was ordered just for pain. I also hope you work day shift and didn't wake a sleeping doc to give the Tylenol for fever. Also, is nursing judgement not a thing anymore?

I do work day shift. He was at the beside with me and requested that I give the tylenol despite the order. I think I decided yesterday that I won't be at the bedside forever either. Kind of a drag considering it's my first month off of orientation.

Pangea Reunited, ASN, RN · May 1, 2015

I'm honestly shocked that so many people wouldn't give it. I even considered that the OP might be joking until I read the responses. If (it wouldn't happen) I felt uncomfortable about not having a "fever" order, I would simply treat the patient's "pain".

SarahJ08 · May 1, 2015

I do work day shift. He was at the beside with me and requested that I give the tylenol despite the order. I think I decided yesterday that I won't be at the bedside forever either. Kind of a drag considering it's my first month off of orientation.

I hope I didn't sound mean, I was not intending too haha. We as nurses are expected to administer and maintain drip like heparin, cardizem, amiodarone, or give iv pain medications, or whatever else potentially dangerous drug. (I've worked tele/stepdown for three years) but I need a doctor's order to give Tylenol for fever when it's ordered for prn pain. What kind of messed up profession is this. Going back to school so I can make the orders and not follow them hah.

gouranga · May 1, 2015

I'm honestly shocked that so many people wouldn't give it. I even considered that the OP might be joking until I read the responses. If (it wouldn't happen) I felt uncomfortable about not having a "fever" order, I would simply treat the patient's "pain".

Well these are things you learn with experience, right? It's not my job to decipher vague orders and make them something they're not. Orders are supposed to be clear and specific. Maybe if it wasn't for something as seemingly harmless as tylenol, you could take my question more seriously.