Hello,
What do you do in the event patient requests a prn pain medication to treat lesser pain when patient has a higher level of pain. For example, patient has a prn pain medication for moderate pain for Oxycodone 10 mg and prn pain medication for severe pain for Hydromorphone IV. Patient has a severe pain (level 8-10), however prefers to get Oxycodone that is intended to treat moderate pain. What do your nurses do in this situation?
Do you have a statement in every prn pain medication order to allow RN to administer prn pain medication as per patient request using medication prescribed lower pain scale? Do you have a policy stating that this practice is acceptable or both? Or do you require RN to call MD each time to get a one time order?
TJC has an FAQ regarding this scenario, see below
https://www.jointcommission.org/standards/standard-faqs/hospital-and-hos...

They recommend: There must be a policy which allows such, the order must include verbiage of such and the medical record must indicate that the patient preferred the less potent agents.

Please share your process at your hospitals!
Thank you,

Viktoriya Fridman, Pharm.D.
Medication Safety Specialist
Ocean University Medical Center
Brick, NJ