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Friday, February 5, 2010

RT Cave rules for PRN treatments

So you have PRN (as needed) treatments ordered on a patient. How much time and attention do you give this patient?

Funny thing is, there are many RTs who work don't even bother checking these patients. They wait for the patient or nurse to call. I suppose, in a way, if you absolutely know the treatment is not indicated, this is fine.

However, there is some liability in that. If you have a PRN treatment, you must at least LOOK at the patient and chart.

Besides, sometimes a doctor respects the RT department so much that they order for PRN treatments even on patients with otherwise healthy lungs just so the RT can continue to assess the patient while the doctor is out of the house. Besides, who does better lung assessments than your humble RTs.

Likewise, some patients ordered on PRN nebs actually could benefit from treatments. Thus, given the argument I give here, those patients ordered on PRN nebs should be given the same respect as treatments ordered at a specified frequency. Or, in other words, a prn neb is that doctor's version of an RT driven protocol.

Thus, you should at least LOOK at your patient. If he is sleeping, chart he was sleeping comfortably. If he's awake, listen to his lung sounds and chart what you find. If the patient is fine, chart as such.

At our hospital we have a policy that this is mandatory. We have to check on the patient with regularity (at least Q4), and we have to chart that we didn't give the treatment and why. Some RTs think this is dumb. I think it's logical. How do you treat PRNs at your hospital

Of course, in a court of law, it'll look better if you charted you assessed the patient, as opposed to wrote nothing for all the days you worked and that patient lied in that bed.
RT Cave Rule #43: However annoying it may be, you should assess treatments ordered prn, and chart treatment not given and why. At the very least you get that all important procedure count, and make your boss happy.


DEB said...

Would you like to share your policy? I am also looking for a good PEP therapy policy if anyone would like to share.


Linda said...

The therapists I have "followed" on clincal days usually dont check on prn patients. Every now and then I follow a therapist that checks on those patients or even goes ahead and gives the prn treatment with the Q4s just because she knows that patient will be calling anyway. I have never seen any charting done on these patients unless the are on O2

Rick Frea said...

Even if you don't actually assess the patient, you should at least LOOK at the patient to make sure they're doing okay. It only takes a second.