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?

Specializes in Adult and Pediatric Vascular Access, Paramedic.

I do hope you also assessed as to WHY your patient was anxious!!

Annie

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I do hope you also assessed as to WHY your patient was anxious!!

Annie

Maybe because the patient has a doctor who "goes off" on someone who asks a question.

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Specializes in Pediatric Critical Care.

TID =/= Q8 hours. Even as standard dosing times they are different from pharmacy.

Q8 would be 0900, 1700, 0100. TID would be 0900, 1500, 2100.

If the MD wanted it to be PRN every 8 hours he needs to write the order as q8h PRN :)

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

TID prn does mean different things depending on who you ask which is why it shouldn't be used. If it's meant to mean "q 8hrs prn.." then it should be written as q 8 hrs. If it's meant to only be given at the pre-scheduled TID times but only when certain symptoms exist at that time, then it should be written as scheduled TID with hold parameters for determining whether it's needed at that time.

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TID prn does mean different things depending on who you ask which is why it shouldn't be used. If it's meant to mean "q 8hrs prn.." then it should be written as q 8 hrs. If it's meant to only be given at the pre-scheduled TID times but only when certain symptoms exist at that time, then it should be written as scheduled TID with hold parameters for determining whether it's needed at that time.

That's your opinion. I don't think there's anything wrong with the way it was written in the first place.

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Specializes in Critical Care.
That's your opinion. I don't think there's anything wrong with the way it was written in the first place.

If an order isn't going to be consistently interpreted the same why by those who wrote it and those interpreting it then that is a problem, and an unnecessary problem at that since there are other ways of writing it that aren't open to the same range of interpretations.

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Specializes in ICU.

This situation came up the other day at my new place of employment. At my old job, if I saw TID PRN I would use my own nursing judgment as to when to give it. I would also discuss this order with the patient to let them know that they could only have this medication 3 times a day. Anyway, I decided to ask another nurse at the facility if they had any protocol regarding this order, and she said "This is 8 hours everywhere." I didn't argue with her, but it is not the case. I think they would specifically write q8prn if the physician wanted it given every 8 hours as needed. However, when I see TIDPRN I try to think about how the medication is usually given normally - 4 hrs, 6 hrs, 8 hrs. I would not give the medication 15 mins later or an hour later if it is not usually given this way. I think 4 hour minimum normally.

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TID prn means 3 times in 24 hours .. with the administration up to nursing judgement.

A lot of nursing judgement will be required , depending on the drug and the scenario.

In this case, if you gave an anxiety med, and X number of hours later your patient remained anxious.. you had the option to administer another dose.

The MD was ticked because you did not utilize your nursing judgement.

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I would have given it prn, according to the agencies definition of TID.

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3 times a day while awake is the safest way i look at it. watch yourself any more than that. md's may say one thing, but if you document what he says without writing an order at that time, you are in trouble. handling people is an art. you'll learn. take time and offer love and patience...even from across the room. sometimes that's all people need....aside from psych.

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TID PRN = 3 times per day as needed

With the demerol example, wait until the peak of the dose. If the dose hasn't worked and the patient isn't loopy, you can safely administer the next dose.

You should also consider "would a doctor order this TID PRN if he did not believe that the patient could tolerate multiple doses close together?"

If I were the doctor and my order was being questioned without the nurse using sound judgment, I would probably be yelling at the nurse in question. When I get my NP, I'll probably be doing it quite a bit. Nothing says "NETY" better than a NP chewing out an inexperienced nurse.

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Specializes in retired LTC.
TID prn means 3 times in 24 hours .. with the administration up to nursing judgement.

A lot of nursing judgement will be required , depending on the drug and the scenario.

In this case, if you gave an anxiety med, and X number of hours later your patient remained anxious.. you had the option to administer another dose.

This is closest to my interpretation.

Like what RX are we talking about?? A valium 0.5mg or valium 10mg needing repeat 2 hours later or 8 hours?

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