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?

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.

NOADLS can't wait to eat all the new nurses. :bag:

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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.

the point of that order is so that you have the latitude to give it without a specific timeframe, based on your assessment and the medication in question. I don't get what's so confusing or difficult to understand about this.

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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.

Agree completely. A TID prn order leaves too much responsibility on the nurse, not enough brains used by the provider.

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Specializes in 6 yrs LTC, 1 yr MedSurg, Wound Care.

In my experience, BID/TID/QID times are for routine orders and basically are meds that are given during awake hours.

PRN orders are written with a set amount of hours apart (q4, q6, q8, etc.), otherwise it's up for interpretation.

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As you can tell from this board, there isn't an agreement on what TID PRN means and if it is up to nursing judgment, the physician is giving a lot of latitude without having assessed appropriately the experience of the nursing staff to make those judgments. I am sure many nurses would be puzzled by this, especially a new grad or nurse with limited experience with these medications to try to judge when it is or isn't appropriate to medicate this patient. I don't recall in nursing school

being taught that we could interpret TID PRN on our own to be any sooner than 8 hours unless you calculate in the leeway time we have to give a medication a half an hour or an hour before or after a med is due. I would check your local policy to see if it defines "TID PRN" and if not, I would continue to request clarification or at least limit re-medicating the patient until after the peak of the med has been reached to avoid over-sedating or causing respiratory depression or arrest in your patient. Error on the side of caution, not on the side of the patient and ignore those on this board who seek to undermine your judgment and attempts to practice cautiously. Remember, it's your license to lose and if something happened to the patient, the doctor would probably throw you under the bus. When I get telephone orders for patients, I think of the nurse with the least experience on our units and try to make sure the order is written in such a way that there isn't too much room for interpretation that could get them and their patients in to trouble.

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Specializes in Critical Care.
the point of that order is so that you have the latitude to give it without a specific timeframe, based on your assessment and the medication in question. I don't get what's so confusing or difficult to understand about this.

TID prn can pretty clearly be interpreted inconsistently. If the point of the order is that the nurse can give doses at any interval, just not more than 3 doses per 24 hours, then that would be "1-3 doses q 24 hrs prn____". If the point is that the nurse can give additional doses after reassessing 30 minutes after each dose, then that would be "1 dose q 30 minutes prn _____ not to exceed 3 doses/24 hours".

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TID prn can pretty clearly be interpreted inconsistently. If the point of the order is that the nurse can give doses at any interval, just not more than 3 doses per 24 hours, then that would be "1-3 doses q 24 hrs prn____". If the point is that the nurse can give additional doses after reassessing 30 minutes after each dose, then that would be "1 dose q 30 minutes prn _____ not to exceed 3 doses/24 hours".

Some nurses have the cojones to work with, and appreciate an order for TID prn, some do not.

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A safer prn order specifies how close together the doses can be given for this patient. Really, they should get rid of that kind of order.

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Specializes in HH, Peds, Rehab, Clinical.

Yup, three times in 24 hours. Of course, following shifts are going to be horked off if you "use them all up" and leave none for them =)

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And then someone needs to advocate for the patient and get an adjustment or change in the medication or dose, because the current order is not addressing the patient's needs adequately.

This is all I kept thinking of reading all the responses up to yours. If the patient is "using up" the doses before 24 hours, then there is a problem.

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Specializes in Critical Care.
Some nurses have the cojones to work with, and appreciate an order for TID prn, some do not.

? I'm not sure it takes less cajones to point out to a Doc how they could better communicate what they want.

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As you can tell from this board, there isn't an agreement on what TID PRN means and if it is up to nursing judgment, the physician is giving a lot of latitude without having assessed appropriately the experience of the nursing staff to make those judgments. I am sure many nurses would be puzzled by this, especially a new grad or nurse with limited experience with these medications to try to judge when it is or isn't appropriate to medicate this patient. I don't recall in nursing school

being taught that we could interpret TID PRN on our own to be any sooner than 8 hours unless you calculate in the leeway time we have to give a medication a half an hour or an hour before or after a med is due. I would check your local policy to see if it defines "TID PRN" and if not, I would continue to request clarification or at least limit re-medicating the patient until after the peak of the med has been reached to avoid over-sedating or causing respiratory depression or arrest in your patient. Error on the side of caution, not on the side of the patient and ignore those on this board who seek to undermine your judgment and attempts to practice cautiously. Remember, it's your license to lose and if something happened to the patient, the doctor would probably throw you under the bus. When I get telephone orders for patients, I think of the nurse with the least experience on our units and try to make sure the order is written in such a way that there isn't too much room for interpretation that could get them and their patients in to trouble.

It was 1mg Ativan IVP. Usually we get that as q4h or q6h PRN. This was the first time I had encountered TID PRN for a med and I enquired about it with my coworkers (RNs with 30-40 years experience) and they were puzzled as well but came to the conclusion that it should be no sooner than 8 hours which seemed odd for Ativan but you know, I don't know everything.

I work nights so "while awake" doesn't usually apply. Though people rarely sleep at night here, most meds ordered "while awake" end at 2200 and resume again at 0700.

Anyway, this is all very interesting because it seems that there is a lot of disagreement about what it could mean. I'm not actually sure of my hospital policy regarding such an order (we have recently been subject to two takeovers in succession so policies are in constant flux and no one seems to be able to get me a straight answer).

I appreciate the discussion though!

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