WHAT TO DO...Nurse is refusing to give PRN medication

[purplenurse1]

I work in long term care. I have a patient that is chronically nausea. The patient asks for his prn nausea medications Q6H on the dot. The day nurse is refusing to give the medications because she feels it in the patient head and he is not really nausea. Myself and the other nurse give the medication if he asks for it because who are we to say he doesn't feel nausea. I have reported this to management multiple time and nothing is being do. I did confront the nurse and ask why she not giving it. She said its a matter of her option he does not need it. What right doe she have to with hold his PRN medication? IS there someone else I should be contacting>

[OBwonKnewbie]

Why is he so nauseated? Vertigo? Chemo? What is the actual cause... If he is requiring a prn that much maybe it should be scheduled or he should be on something else to deal with the cause of his nausea?

[purplenurse1]

he has all testing done by gastro everything is neg so far

[OBwonKnewbie]

Does the zofran actually seem to work for his nausea? Does he eat his meals? Does he actually vomit?

[ED Nurse, RN]

Write an incident report each time the pt states they have not received the prn medications- include date, time, reason the nurse told the pt they could not have the med.

[jadelpn, LPN, EMT-B]

There is a difference between Zofran, which makes some patients tired, and old school stuff of which the name escapes me at the moment oh, yes, Compazine,or phenegran or even Ativan for nausea. They all can help, however, all very different medications. And dependent on which nurse you talk to, can cause all sorts of a "high".

All of which is an absolute moot point in that the primary care provider for this resident prescribed a medication for the nausea that is PRN Q 6 hours. So if the resident asks for it, they are to get it. Unless there's some contraindication in the moment. And if there is something else happening (like not tolerating due to _____) then the nurse is supposed to call the provider for direction. It is called ethical and legal obligation.

There's an omsbudsman in the facility I am sure. That person needs to know this is happening. You could also say this is neglect, as the resident has the right and the prescription to not be nauseated. If the powers that be are not doing anything, you need to take it up the chain of command, and report it.

Unfortunately because you have witnessed this, the nurse admitted to you that she is declining to give it AS ORDERED, you now have the obligation to do something about it. Which adds you into her passive aggressive nonsense. How freaking awesome! Not.

An instant solution would be that the resident asks for it, the nurse won't give it, so you go to charge and report it, and charge gives it, and disciplines in that moment said nurse.

Also, depending on what this is, are we sure that there's no diversion going on? There are residents who do receive Ativan or Xanax for nausea. Just a thought.....cause something is really weird about this.

[purplenurse1]

The resident is on xanax bid. For anxiety. She feels that the nausea could be anxity which it maybe, but who is she to denie zofran when we have orders to give it. I have repeatedly reported her to management and nothing has been done. Who else should i report it too?

I have been working with his doctors to try and find the cause of this nausea so far no luck. I have suggested that the nausea could be from his meds. So that our next step with his doctor.

[purplenurse1]

I have to and gave to management.

[%D#2]

Call the doctor.. Tell them the situation and that you want it scheduled

[purplenurse1]

Zofran does seem to work. He eats just fine. No vomiting

[nutella, MSN, RN]

Sometimes having the doctor schedule the med as opposed to PRN is what will help with this problem.

[Here.I.Stand, BSN, RN]

Sometimes having the doctor schedule the med as opposed to PRN is what will help with this problem.

I was going to suggest this exact thing. If he needs it q 6 hrs on the dot, it should be ordered q 6 hrs.

Otherwise, you can Google LTC ombudsman for your state, call them and report the situation/ask for advice. Somehow I doubt TJC would look too kindly on Rx'ed meds being withheld.

FWIW, I agree with you. That would be great if the care team comes up with a treatable underlying cause for the nausea...but unless or until that happens, the resident should be able to expect relief from his available Rx. Somehow I doubt the nausea is anxiety related if the Xanax helps the anxiety sx but resident is still nauseated. But even if it were anxiety related, what does that matter? That's like saying "Yes we know the pt has hip pain; it's related to his recent THR" and therefore not giving Percocet.