What does this order permit? In terms of frequency?

[Della4]

Tylenol 3 

Take 1 to 2 tablets daily when required for pain. Max daily limit 3000mg from all sources. 

Is this only one per day or when needed (perhaps more than once) or only 1 per day? Or when required as long as the 3000mg limit is not exceeded? 

Thank you. 

[hppygr8ful, ASN, RN, EMT-I]

I might also since you mentioned Ativan that it can typically be given every 4 to six hours as needed. You might want to brush up on your medication knowledge with regard to efficacy and half-life so you can help the patient and family know what quest to ask the physician 

2 minutes ago, Della4 said:

That's what I thought too! Thank you. I will get a clarification first just in case. My colleagues are split on what it means, most will not do more than one. 

Then they are doing the resident a diservice with regard to pain control.

[Asdf]

I gotta say, this is confusing. The way I would interpret this order is that they can have 1 OR 2 Tylenol 3 ONCE a day.  Having said that I think it’s a poorly written order and I think all the different interpretations of said order by different people here backs that up.  I think you’re right to speak to the prescriber to clarify regardless of whether  the patient and/or the pt’s family is “managing” their RX.  If that were the case, you wouldn’t have a order and the meds wouldn’t be locked up.  You should do what YOU think is right, both for you and the pt,  if the MD/PA/NP gives you *** about calling to clarify they can stick it, and then clarify their poorly written order.  If/when management/admin gives you ***, that’s just par for the course.  Good luck to you and keep looking out for your patients and yourself.  

[hppygr8ful, ASN, RN, EMT-I]

As a chronic pain patient I was a one time taking norco 5/325 2 pills three times a day. At one point I inherited a new doctor who had this idea that I should not be taking it at all. A pain management doctor held firm and over the past 2 years we have slowly decreased the dose and timing until I no longer take it. I now get massages, acupuncture and other alternative treatments. I still have a certain amount of intractable pain but I no longer have to justify it to a physician who put policy over patient care.

[JKL33]

It isn't wrong to reach out to the prescriber since it is employees at your place who are having a hard time understanding what the order means. In general though, with your additional information it sounds like they have chosen the level of service that they want, so if it weren't for the confusion about what the order means I would say there's nothing wrong with kicking it back to patient/family to have them contact their HCP if they don't think their medication is adequate.

 

8 hours ago, Asdf said:

The way I would interpret this order is that they can have 1 OR 2 Tylenol 3 ONCE a day.

That is correct. The frequency is given; it is daily. Daily does not mean twice per day. It means once per day.

 

[Della4]

13 hours ago, hppygr8ful said:

As a chronic pain patient I was a one time taking norco 5/325 2 pills three times a day. At one point I inherited a new doctor who had this idea that I should not be taking it at all. A pain management doctor held firm and over the past 2 years we have slowly decreased the dose and timing until I no longer take it. I now get massages, acupuncture and other alternative treatments. I still have a certain amount of intractable pain but I no longer have to justify it to a physician who put policy over patient care.

I find this happens allot! Dr. Worry about prescribing too many opiates and forget that most people take their medication as prescribed and for the intended purpose! This really makes me mad when I have a patient that genuinely has pain and needs these medications and doesn't get it. Or doesn't get enough or is considered "drug seeking". 

This is another thing. Any person who has an ailment is technically "drug seerking" someone has neuro pain seeks gabapentin, someone has diabetes 1 seeks insulin. 

A person who has severe pain, seeks an opiate = drug seeker. Yeah, they are seeking to relieve their pain, doesn't mean they are a drug addict. Tolerance, dependency and addiction are separate things. 

Or someone sent home with an opiate order, didn't ask, doesn't want it and gets a high dose 30 day supply. Someone who has serious pain, asks for an opiate is denied and treated like a drug addict.  

Reminds me of the "over prescribing antibiotics" and discouraging the use of antiseptics because this can lead to drug resistant antibiotics. What happened? Dr went loopy, decreased antibiotics and a spike of sepsis ER visits. People stopped using antiseptics and more infections. 

Where as yes there is a drug addiction crisis and yes the overuse of antibiotics and antiseptics can cause problems. Doesnt mean we go to the extreme and cause more problems. 

There have been cases where people who have been prescribed opiates for a time, took them as intended and didn't abuse them and then were almost cut off entirely.  We have seen people resort to street opiates to relieve pain and yes withdrawal because they had no other choice only to end up dead from fentanyl. 

Off topic, I could go on and on and on!! 

[hppygr8ful, ASN, RN, EMT-I]

It sounds as if you really do want to do right by your patient. In your original post you stated that the patient's pain was not being well controlled. Regardless of the patient's status in your facility you are still his/her advocate, Most assisted living facilities do have ability to set up appoinments with pain management specialists. While the order is cleary for once per day it needs to be questioned with either the prescribing physician, the family or both. You can advised your patient on how to be their own best advocate.

There is so much mis-information about opiodes out there that needs to be clairified so that legitimate pain patient's have access to their medication. Becaus both Tylenol and codiene are relatively short acting They usually need to be given more than once per day to achieve adequate pain relief. 

When my mother in law was dying of a glioblastoma she was in an incredible amount of pain.  She had morphine scheduled hourly as needed. This was hospice which is pretty liberal with pain meds. My husband did not want her to have this much Morphine as he was afraid she would get addicted. The physician told my husband that  the med was absolutely necessary and that if her brain tumor miraculously went away he would send her to rehab. 

Hppy

[sleepwalker, MSN, NP]

On 7/29/2022 at 8:59 PM, chare said:

As the order is written, I interpret it to mean a once daily dose of either 1 or 2 tablets.  As you wrote above.  The max daily limit of 3000 mg refers to total acetaminophen in a 24 hour period.

This.