What does TID PRN really mean?

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Hey friends, I recently had a pt with a medication ordered TID PRN and gave a dose of this antianxiety medication early in my shift and the pt became anxious again several hours later. As TID means three times daily, I always translated that to mean every 8 hours. So I called the MD and requested an additional dose for the pt and the MD went off on me. I'm used to this guy flying off the handle but he basically told me I was stupid and that TID means I can give the medication every five minutes if I want to as long as I don't exceed three doses a day. This...doesn't sound right to me but I'm putting it out here to see what you guys have to say. Can you give a TID PRN medication as frequently as you need to?

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TID does not mean q8H - it means three times a day - the doses don't have to be equally spaced out. As long as your *assessment* doesn't reveal a contraindication to giving the medication, go on and give it.

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Specializes in geriatrics.

TID PRN means three times a day, as needed, for a maximum of 3 doses. This does not mean every 8 hours.

If your patient was anxious several hours later, you could have administered a dose without calling the MD.

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Specializes in Psych (25 years), Medical (15 years).

A window of time between doses would be a prudent action.

In this situation, I would space them out at least about every four hours and no closer than one hour.

I had a similar situation. The MD wrote an order for Demerol 50mg IM TID PRN pain. Then, he crossed out the "TID PRN" and wrote in "q8hr."

The Patient wanted her dose after about 4 hours and I said I couldn't give it; only at or after 8 hours. The Patient wanted the House Supervisor contacted. The House Sup said it would be okay to give and I refused, so the House Sup gave it.

Sic semper tyrannis.

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TID does not mean q8H - it means three times a day - the doses don't have to be equally spaced out. As long as your *assessment* doesn't reveal a contraindication to giving the medication, go on and give it.

Ok thank you for the clarification. I always like to check if I'm not sure. Whenever we have dressing change orders that are TID they are done every 8 hours so this is what I had in mind.

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Specializes in Critical Care.

If the Doc wanted you to read that as: 1 dose as often as every 5 minutes and not to give more than three doses per day then that's what they should have written: "1mg q 5 minutes prn ___ NTE 3mg per 24 hrs".

TID and q8hr usually don't mean the same thing. TID means the medication is to be given on the predetermined TID schedule, usually in the AM, mid-afternoon and bedtime.

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Yeah I rarely see TID PRN. When meds are ordered TID they're scheduled by pharmacy like you said Muno, morning, afternoon and night. I think he was exaggerating about the every 5 minutes part but who knows. He's the overnight hospitalist so it's not like I woke him up at home or anything, he called me back from his office downstairs.

¯\_(ツ)_/¯

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Ask for a clarification "do not give any closer than 1 hour apart" or some other such nonsense......

If this was a give every 5 minutes thing, then he could clarify it to say that......which for Ativan is perhaps not the most prudent thing.....

Or, he could just order it for 3 times a day, and patient could refuse

Or perhaps I need more coffee.

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If the Doc wanted you to read that as: 1 dose as often as every 5 minutes and not to give more than three doses per day then that's what they should have written: "1mg q 5 minutes prn ___ NTE 3mg per 24 hrs".

TID and q8hr usually don't mean the same thing. TID means the medication is to be given on the predetermined TID schedule, usually in the AM, mid-afternoon and bedtime.

Disagree with paragraph 2. TID scheduled means scheduled on a pre-determined TID schedule. TID prn isn't the same.

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Ok thank you for the clarification. I always like to check if I'm not sure. Whenever we have dressing change orders that are TID they are done every 8 hours so this is what I had in mind.

The difference is in the added prn. Dressing change TID is am, pm and hs approximately, dressing change TID prn is change it up to 3 X day prn saturation/displaced/comfort. Same for meds.

Nursing judgement comes in when the need becomes more frequent than symptoms can be managed after the 3rd change or dose.

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Specializes in SICU, trauma, neuro.

I've always given it up to TID with nursing judgment, not q 8 hrs. Q 8 hrs prn does mean at least 8 hrs between pen doses.

That said, it was totally inappropriate for him to "go off on you."

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Specializes in Med/Surg/ICU/Stepdown.

FWIW, my hospital's MAK system will not allow a TID order to be given any sooner than q8hrs. Scanning the medication early will prompt a warning.

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