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>

[TheCommuter, BSN, RN]

What right doe she have to with hold his PRN medication?

As nurses, we have the right to withhold PRN medications for justifiable reasons...

However, the action of holding the medication should be followed up with some other prudent action, such as notifying the physician to see how he/she wishes to proceed. There's a problem whenever a resident requests the same PRN medication every six hours on the dot. The underlying issue (nausea) needs to be addressed.

[%D#2]

Whatever the cause us, it needs to be treated and monitored, until there is more information . Yes monitor for adverse effects but to refuse to give and leave a pt nauseated? I agree with searching for neurological causes. Have you tried ginger? I used to give that to some of my chemo patients. I still say get the zofran scheduled until you find a solution/alternative

[scjudyb]

I have to agree with the person who recommended an Incident Report. This needs to be reported.

If she won't give the nausea meds, what else is she deciding not to give? Let's get this nurse educated on proper care. There may be valid reasons for making any medication round the clock, but we don't get to refuse to administer meds based on our opinion.

[citylights89, BSN, RN]

did they do an x-ray of his abdomen for part of his testing? my Mom was nauseous all the time until she was rushed to the ER and they found an abdominal perforation. It was too late at that point.

[litbitblack, ASN, RN]

The nurse needs to give the PRN or have her boss give it if she doesn't feel comfortable. The nausea needs to be f/u on but the patient shouldn't be refused treatment because a nurse doesn't believe there is nausea. Maybe the pt is anxious because she is afraid she won't get her nausea medication therefore making it worse.

[%D#2]

Some people think that because it's a PRN it is not "needed" and this is untrue.. It may not be needed all the time. But when it's needed, it's needed! I do have patients on zofran long term and yes there are effects of that but those should be monitored and comfort should be a priority as well. When I find that I am giving a prn on the dot, I call the doc, and I get an order for it to be scheduled. I would do that.. See what she does then!

[DialysisRNBS]

What I would do is report the nurse to the nurse manager again. Let the nurse manager know if she is ok with a nurse not giving an order medication at the patient's request then you will have to take this to a higher authority if nothing is done to correct this other nurse's wrong actions. If the nurse manager does not do something to enforce meds to be given then you need to go to the doctor that ordered it and/or higher authority in your olace of work and report that patient (give name) is not being given nis order med (name med) by (name nurse). And like other nurse here said, file an indicent report or document it in your nursing notes that pt x said med not given to him and nurse x admits to not giving med. then document when you gave the med.

I think the dr who ordered it needs to know this nurse is ignoring his order.

[jacksonvillelpn]

Zofran is supposed to be used to prevent nausea/vomiting caused by cancer treatments and surgery. It has also proved to be effective in treating gastroenteritis. However, one of it's side effects can be...wait for it...nausea/vomiting. Is the patient on chemo or radiation therapy? Have any other interventions been tried with this patient? Does he actually vomit if he does not get the zofran, or how does he do without it? How long has the patient been taking the medication? Is giving it RTC prudent or advisable? These are all questions that should be addressed by the patient's care team and PCP.

[sarose611]

If the patient needs the medication, he should receive it. But patients can also develop psychological.dependency. Or the side effect of making him.drwsy helps him escape a situation where he is unhappy. You report he has had ectensive GI workeps, but there are many other causesnausea, from inner ear problems to.low blood sugar or low blood pressure. He may .s lso.benefit from a psych eval to rule out depression. Maybe suggest to.the day nurse that she postpone the dose, rather than refusing to administer at all. Maybe that could help identify if tjis iury s "all in his head" or if he routinely has areal.need.

[SuzanneP54]

Canada Dry also has real ginger. There is a list of all types of ginger ale with real ginger on the internet.

[evilnrse67]

Reporting this to the prescribing MD is a must, especially if management is not responding. Document everything, including reports to management. Had the DON been made aware of this situation. As nurses, we have to use our judgement, however it sounds like this nurse is taking it too far, an acting out of her scope of practice. Remember, even if it is in the pts. Head, it is up to the Drs to address. That nurse is wrong. Period.

[evilnrse67]

I have chronic pancreatitis, one of the side effects I live with daily is constant nausea. I take all the correct meds , including creon, I have a GI specialist I work with and have my work ups Q 3 months. Still , nausea is a constant.