Published May 6, 2003
I work on the 11a to 7p shift at a Assisted Living Facility. My Director seems to have her own agenda when she writes med order on the MAR. When a resident has a Tylenol PRN order. She insist on writing down times to be given 8a, 12p, 5p, 8p. So when the resident ask for Tylenol at 1a, there is no where for me to sign out. I keep telling her that she is writing a Prn as if it were a standing order. But she will not change it in the MAR. It was to my understanding that you put the time down when the resident ask for the med. The order does not say QID, but prn every 4 hours. What do I do? She is the Director. Thanks, a LPN who knows he is right.
USA987, MSN, RN, NP
Tough situation here. You are right. But how do you approach this in a professional manner? I'd love to hear others input on this matter...
I think I would address it this way:
1. Make sure the order states "prn" (altho it sounds like you already have)
2. You do not say if the Director is a nurse. I have worked as the house RN for assisted living. I know that most Directors are not nurses. So, who is the RN? If you do not have a house RN, the facility you work for should have an RN employed in the corporation and you should consult her/him.
3. I would give the drug at the appropriate times as needed, cross out the time at the top of the MAR and initial it, then write the time you administered the drug, the date, and your initials. Then, in the patient's chart, or wherever you do narrative, indicate exactly what you did.
Ex: 05-06-03 @ 0100 hrs: Mrs. Jones c/o HA in frontal sinuses. Rates HA a "4 or maybe 5" on a 10 scale, "throbbing". VSS with BP 122/80, T 98 oral, R 16, P 76. No associated other problems. Requested Tylenol. Administered Tylenol 650mg PO as per MD orders for PRN Tylenol (see MD order dated 05-01-03). D. Smith,LPN.
By writing the info on the MAR and ALSO completing the narrative this way, you are absolutely covered legally. Also, make sure you return to the patient an hour or so later and determine and DOCUMENT the effectiveness of the Tylenol.
If this ruffles the feathers of the Director, simply point out that you have followed the MD orders. Remain professional in your actions, but don't let the Director keep you from giving needed pain medication to the patient. You are there to help the PATIENT, not the Director. The key is, you are following the MD orders!!!
Thank you so much for the great advice. My Director is a LPN who has been a nurse since 1975. But has worked at 2 Assisted living Facilities up until she started at this place last year, which just opened. I myself have been a LPN since 1986, but have worked many places (4 Hosp. and Nursing Homes ). It seems to me that she has a problem when I tell her things that are not right. Which I am very careful on how I approach her. Hopefully, this will take care of everything. This was not the first time it happened. Will keep you posted RegNursein99.
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