Range Orders

Now that we're a few years out from the Joint Commission's suggestions on Narcotic range orders, I'm curious what the response has been; How many facilities have done away with range orders all together? How many still use range orders but have significantly altered the policies regarding their use?

Where changes were made, was there any noticeable change in rates of oversedation or other adverse events? Was there any noticeable beneficial or negative effect on pain control?
Our facility actively fought to keep range orders. We now no longer have range orders such as "give 1 to 10 mg morphine IV q4 hrs prn" but we still have range orders such as "1-2 lortab 5, q4 hrs prn". The huge ranges, which were inappropriate in my opinion anyway, are no longer allowed, but the smaller ranges are.Our facility's stance was that it is entirely appropriate to have nurses use their judgment to determine whether a patient needs one or two lortab. We did not get dinged on it, we defended ourselves well to them apparently.

My facility no longer allows range orders of any kind and has not allowed it for several years now. What you end up with is several more orders for pain medications of varying doses instead of just one range order.To me it seems like the end result is exactly the same.

we have a policy stating how range orders are to be interpreted but are seriously looking at eliminating the whole idea.

Quote from BluegrassRNOur facility actively fought to keep range orders. We now no longer have range orders such as "give 1 to 10 mg morphine IV q4 hrs prn" but we still have range orders such as "1-2 lortab 5, q4 hrs prn". The huge ranges, which were inappropriate in my opinion anyway, are no longer allowed, but the smaller ranges are.Our facility's stance was that it is entirely appropriate to have nurses use their judgment to determine whether a patient needs one or two lortab. We did not get dinged on it, we defended ourselves well to them apparently.