Clarification of PRN orders or no

[xiphoid2010]

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While staffing, you see orders that can be either co-exist or override each other.

Eg. One order, vicodin 5/500, 1 po q4h prn. Then another order few days later writes vicodin 7.5/325, 1 po q6h prn, no d/c of the other order. Sometimes i think physicians dont read progress notes or know their patients.

Any who, who would put both on profile? Who would override first with 2nd order? Who would call and annoy physicians with what some might consider trivial?

I have done all 3 for various reason, or no good reason. Don't think there is an absolute right answer. Just want to see what you all do out there.

 

[ethyl]

While staffing, you see orders that can be either co-exist or override each other.

Eg. One order, vicodin 5/500, 1 po q4h prn. Then another order few days later writes vicodin 7.5/325, 1 po q6h prn, no d/c of the other order. Sometimes i think physicians dont read progress notes or know their patients.

Any who, who would put both on profile? Who would override first with 2nd order? Who would call and annoy physicians with what some might consider trivial?

I have done all 3 for various reason, or no good reason. Don't think there is an absolute right answer. Just want to see what you all do out there.

If it's the same drug, I replace the old PRN order with the new. If it's a different drug that is also 'PRN pain', per JCAHO we have to clarify with the MD the different pain scales for the two pain meds. Otherwise, the nurses end up practicing medicine by choosing between the two 'PRN pain' meds based on their own judgment.

 

[type b pharmD]

If it's the same drug, I replace the old PRN order with the new. If it's a different drug that is also 'PRN pain', per JCAHO we have to clarify with the MD the different pain scales for the two pain meds. Otherwise, the nurses end up practicing medicine by choosing between the two 'PRN pain' meds based on their own judgment.

This was the standard practice where I worked. Sometimes i swear doctors would change the combo strength or sig every other day for prn pain meds. It got annoying.