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>

[purplenurse1]

Tried today with md does not want it as a standing order. Will keep reporting to management. I also spoke with the patient to go to case manager everytime he is refused the med.

[akulahawkRN, ADN, RN, EMT-P]

Tried today with md does not want it as a standing order. Will keep reporting to management. I also spoke with the patient to go to case manager everytime he is refused the med.

If the patient speaks with his/her case manager every time a PRN medication is requested for something and it's appropriate, management will eventually come to an understanding that this could end up becoming a problem for them. It's not so nice when a licensing body comes in for an inspection as a surprise. That nurse might not like it much if the BON investigates withholding of medication unnecessarily... though you might get caught up in the fireworks.

I generally give all the PRN medications that I can... when they're indicated. It doesn't matter to me if the patient is drug seeking, I'll chart the request and communication with the MD as well as the response from the MD about it, as well as my own observations regarding the request. That way if the MD refuses to order a medication, it's obvious why.

Things get more interesting when the patient is on a pain management plan...

[iluvivt, BSN, RN]

This nurse is either lazy or has control issues.Another reason some nurse will not administer prn is plain fear.They do not trust their own assessment skills or lack them and must be told exactly what to do.Either way it is not acceptable and is substandard care and neglect. I would speak with the nurse and explain this to her.You would be suprised what BRNs reprimand for...a lot less than this.If this nurse has a patten of doing this and several incidents are reported their is a high likelihood the nurse will be punished. The BRN is there to protect the public.Please order and read your nurse practice act and take a look at what nurse are reprimanded for . most are ETOH and drug related but the others are incidents just like this. They get a lot of nurses on falsification of documentation too.

[quiltynurse56, LPN, LVN]

Zofran works better if given before the nausea gets bad. Once you are extremely nausea to actually vomiting, it is too late and will take longer to get on top of it.

At the LTC where I work, we have extra documentation for PRN meds. If you do, maybe she just doesn't want to do that extra work too. It really isn't hard to document though. That brings to mind, make sure you document in the nurses notes when he is getting it and why. Documenting it other than the MAR will be useful too.

Edited: Also make use of the non-medicinal helps for nausea. 7-Up and saltines. Some people find other carbonated beverages help better than the 7-Up

[/username, BSN, RN]

Has this patient been worked up for any kind of neurological disorder, or just GI?

[Kooky Korky, BSN, RN]

How's the gall bladder? Get an ENT consult, too. Is anyone wearing fragrance around him - flowers, hair or body care items, laundry detergent or other laundry products?

Liver OK? Housekeeping products? Nasty (to me) room fresheners?

Sometimes a little Emetrol or Dramamine will help nausea and/or a little food intake will settle the stomach.

Get the Pharmacist involved to check all possible med side effects and interactions.

[purplenurse1]

Just gi

[Kooky Korky, BSN, RN]

There is one brand of ginger ale that contains actual ginger. Could you get that for her? Ask family to supply it maybe? Pharmacist could tell you which it is maybe.

Don't seek to get the nurse in trouble with BRN as suggested above. But maybe Doc could talk to her and/or to Management, and Doc could do more of a workup.

[OneDuckyRN]

In Michigan we swear by Vernor's, but if the resident is needing Zofran q6h, it may not help him much. It could be worth a try, though!

[BuckyBadgerRN, ASN, RN]

Any good provider will recognize the frequent PRN use and just schedule the dang med. I don't understand what the problem really is

[mrcn23]

well PRN q6hrs is after 6 hours the patient can request this med and get it for only nausea and/or vomitting. Not for any other purpose. If the patient does not have nausea or is not vomiting then the medication desire is like me getting my alcohol from the fridge every 4 hours because i like the way it makes me feel. The doctor has to write a progress note as to what is causing this behavior. if my patient wanted benadryl every 6hrs prn then ill have to find out whats causing the itch, i wont just give it because he/she likes the feeling.

[NanikRN]

well PRN q6hrs is after 6 hours the patient can request this med and get it for only nausea and/or vomitting. Not for any other purpose. If the patient does not have nausea or is not vomiting then the medication desire is like me getting my alcohol from the fridge every 4 hours because i like the way it makes me feel. The doctor has to write a progress note as to what is causing this behavior. if my patient wanted benadryl every 6hrs prn then ill have to find out whats causing the itch, i wont just give it because he/she likes the feeling.

Zofran in no way compares to your alcohol from the fridge

1. It doesn't have a mind altering effect

2. Pt is asking because of nausea-- nurse doesn't believe patient's nausea is real

3. OP states pt is being worked up by GI and pcp sounds active on case

4. It's zofran -- geez, just give the med as ordered and stop playing judge and jury.