What would you do?

No reason to give it unless the patients status called for it. I'd document that the patient received percocet at 8.

~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~

That would depend upon why it is ordered. Technically and legally they are 2 separate orders so if I decided to hold the Tylenol I would document a good reason. Can the patient tolerate up to the 4 grams?I thought the makers of Tylenol changed their recommendation to not exceed 3 grams in a 24 hr period now.

They have max strength Tylenol (1,000mg), too. As for the scheduled 650mg TID, it would depend on why the medication was ordered. It also depends on how much Tylenol the patient has received. And from what I am understanding from your post, the patient received two doses of 650mg Tylenol (=1,300mg) + two doses of Percocet 5/325 (=another 650mg Tylenol, equaling to 1,950mg total.) Another 650mg that is due at 9 would put the patient at 2,600mg, which is cutting it close since the max recommended daily dosage of Tylenol is now at 3g/day instead of 4g/day.

Chances are the patient is on scheduled Tylenol because they have been spiking fevers or they have been complaining of headaches. Even so, wouldn't the Q4H PRN Percocet help with both?

I also thought the new thought process was not to exceed 3 grams in 24 hours. And at the rate of scheduled Tylenol, as well as a PRN that is q 4 that contains Tylenol, that is a whole lot of Tylenol. And remember, this is in a 24 hour period of time. Perhaps see if the scheduled Tylenol can be changed? Even to something like Ibuprofen? (which would not be q4, however, you have a prn percocet that is closer in time that can be given). NOT giving medical advice, per TOS, but I would discuss with the pharmacist to see what the best course of action would be.

A lot of our patients followed by the chronic pain APNs receive around the clock Tylenol as part of their pain meds. However, they are usually on Oxy vs. Percocet. Maybe that kind of switch is needed.

Why is this patient receiving scheduled Tylenol? If it's for pain management, does he or she have a pain specialist on board?

I would request that the percocet order be changed to oxy. You caught the issue, but perhaps another nurse wouldn't and the pt would get too much tylenol. It's a patient safety issue.

As for the original question, I would probably speak to pharmacy about it, and base my decision on that.

I think you all are right, MDD of Tylenol is now 3gm. This patient is in a LTC setting, and it seems to be a trend that they prescribe tylenol regularly for alot of the residents. This particular patient is S/P right hip fx repair.