Starting Aug. 16, our orders for pain medications can no longer have default instructions that allow nurses to pre-medicate a patient for anticipated pain due to activity or a procedure (i.e. physical therapy, a chest tube placement, etc.).
On August 16, 2022, orders for pain medications began not including default instructions. that allow nurses to pre-medicate a patient for anticipated pain due to activity or a procedure (i.e. physical therapy, a chest tube placement, etc.).
If a patient will have a procedure that is likely to cause an increase in pain, pre-medication is only permissible with a specific provider order (i.e. oxycodone 2.5 mg PO PRN 30 minutes prior to physical therapy sessions). The same could apply to dressing changes, etc.
This change is a result of a finding during the Joint Commission's accreditation survey of the Joint and Spine Centers of Excellence. There was concern that the following phrase (found in almost every one of our pain orders) could result in inadvertent over-medication of our patients:
If increased pain is expected due to impending procedure or activity, you may use a medication ordered for one level higher than the current pain score.
This language leaves nurses in the position of making a prescribing decision. This change will ensure that provider judgement (rather than “RN prescribing” will determine the medication a patient is given prior to a procedure.
If you have questions or ideas about standard PRN reasons we should add to pain meds to help you make this process easier, please contact Matt Tanner in Pharmacy (4-9960, matthew.tanner@salemhealth.org) or Cheri Blevins in Accreditation (4-2089 or cheri.blevins@salemhealth.org)