range order rationale

So you've got an order for 1-2 Norco q 4hrs prn pain, you give 1 at 1200 for 6/10 pain. At 1330 their pain is still 4/10, does you interpretation of the order allow you to give the second or do you have to wait until 1600? How would you interpret this and more specifically why?

I know there have been other threads on the subject of range orders but what I haven't been able to find is rationale for different views that exist on these threads. I'm having a hard time understanding why so many nurses believe a medication ordered as a range order can only be administered once during the timeframe rather than titrated to effect, please enlighten me.
Because you were to give one or two every four hours, then you need to wait the full 4 hours before you can administer again, unless you have a doctors order to give another one or two, sooner. Why, because that is what the order said. You gave the one. Now you will assess it's effect for the next four hours. You may then decide to give two or continue on with the one. PRN meds have to be given as written, or at the end of 24 hours, you would have given an extra dose.

Range orders are not allowed at my facility. It would be more like:1tab q4 PRN for pain 1-62 tabs q4 PRN for pain 7-10.So I'd give one tab and wait 4 hrs to give the other.

IMO, you give another one. The order is written that way on purpose so you have some flexibility to correctly manage pain. The way I see it, the Dr. "allows" for 12 Norcs per day, so the total dose allowed per day will be the same if you give 2 norcs Q 4hrs, OR 1 norc Q 2hrs.I have not had this situation arise, and am curious if my thinking is right???Actually, after reading the previous posts, i see that I am incorrect. Gotta give it the way it was written.

I think this would depend on what kind of pain the pt is having, how big they are, are they used to taking narcotics? This is where your nursing judgement comes in,..but I would do just as you say,..give one, if in an hour and a half the pt is still in pain and requesting more meds I would give the second one.

Quote from Chin upBecause you were to give one or two every four hours, then you need to wait the full 4 hours before you can administer again, unless you have a doctors order to give another one or two, sooner. Why, because that is what the order said. You gave the one. Now you will assess it's effect for the next four hours. You may then decide to give two or continue on with the one. PRN meds have to be given as written, or at the end of 24 hours, you would have given an extra dose.

Quote from glutton4punishmentIMO, you give another one. The order is written that way on purpose so you have some flexibility to correctly manage pain. The way I see it, the Dr. "allows" for 12 Norcs per day, so the total dose allowed per day will be the same if you give 2 norcs Q 4hrs, OR 1 norc Q 2hrs.I have not had this situation arise, and am curious if my thinking is right???Actually, after reading the previous posts, i see that I am incorrect. Gotta give it the way it was written.

Quote from CCL RNRange orders are not allowed at my facility. It would be more like:1tab q4 PRN for pain 1-62 tabs q4 PRN for pain 7-10.So I'd give one tab and wait 4 hrs to give the other.

Quote from glutton4punishmentIMO, you give another one. The order is written that way on purpose so you have some flexibility to correctly manage pain. The way I see it, the Dr. "allows" for 12 Norcs per day, so the total dose allowed per day will be the same if you give 2 norcs Q 4hrs, OR 1 norc Q 2hrs.I have not had this situation arise, and am curious if my thinking is right???

Quote from RN-CardiacI agree with you. As long as you don't exceed the 12 doses in 24 hours I would give the second tablet. For those of you who wouldn't give the second one, what would you do in an hour and a half when the pt is still in pain and asking for meds?

Quote from Chin upNo, I don't believe this is correct at all. The order does not say one tab every two hours. It says every four. If you donitnyour way, you are prescribing meds. But say you gave 1 at 12, then 2 at 1:30, 2 at 5:30' 2 9:30, 2 at 130 and 2 at 5:30 and 2at 9:30. That would be 13, not 12 in 24 hours.

Quote from Chin upCall and ask for a new or stat order. Nurses are not allowed to prescribe meds.

Myself, I'd give the second at 1330 and that'll be all until 1730; the pt had all the dose at 1330. Now my work has been improving range orders. Norco X/325 1-2 tabs q4-6prn and morphine 2-4 mg IVP q 4-6h prn comes on our MARs:Norco 1 tab PO q 4h for pain 1-3Norco 2 tab po q 6 h for pain 3-5Morphine 2 mg IV q 4 h for pain 5-7Morphine 4 mg IV q 6 h for pain 8-10Which is nice because it means that pts have standardized dosing for set pain parameters regardless of which nurse is working. But, I argue, what about giving morphine 3 mg IV or norco 1 1/2 tabs? [clearly allowed in the written range order ]