Oxycodone 5mg #30
Sig: 1-2 Tablets PO Q4-6H PRN pain
Why?
Here's why. We see that and of course, per your instructions, we type up the label as:
Take one to two tablets by mouth every four to six hours as needed for pain
But here's the fun part. We counsel the patient, sometimes even suggesting that they start with 1/2 tablet to start... you know, just to see how it goes. They nod as if they're listening to us and understand. They get their sack of meds, head home, read the label, and this is how they see it:
Take 2 Tablets by mouth every four hours...
And then they think: As needed? Ha. I'll take it whether I think I need it or not. In fact, I might just take 3 tablets every 3 hours.
The patient, almost without exception, will begin taking the maximum dose prescribed, even exceeding it in some cases.
Sooooo.... doc, still with me? I grow weary of typing these up. Instead of the aforementioned Sig, just write the maximum dose you'd like the patient to adhere to and let's hope they listen. Ok?
Take heart, dear medicine man! Some folks (like everyone in my immediate and extended family) don't want to take it all, but live quite a ways from town and even further from a 24-hour place. So when surgery is had (or some other unfortunate event occurs), we fill the RX just in case the nighttime pain is too bad, end up taking, at most, two half-doses (since all of us feel like crap when we take them), then have a bottle of pain meds to dispose of. Live on the other side of the coin, ha! Have a good one. Deb
ReplyDeletePain meds to dispose of? What is this dispose, of which you speak?
ReplyDeleteThis is all too true. I used to work for a doctor who was very generous with controlled scripts, we had more than the average amount of abusers at that practice and this does not apply to normal patients. The following took place multiple times each day:
ReplyDeletePatient got Rx for whatever narcotic qXh prn (doctor's favorite letters of the alphabet were P,R, fucking N)
Patient interprets "as needed" to mean whatever they want it to
15-20 days later patient runs out
Patient calls in for an early refill
I (the nurse) say nope, that's not allowed
They insist
I ask doctor
Doctor says nope
Patient says "but it said take as needed"
I try to explain and create a 5-10 minute phone conversation for myself each time
In the end patient still repeats "but it said take as needed"
Every damn time.
Seeking patients never learned because they thought this was some kind of magic loophole to be used to their advantage and the doctor never learned to stop writing PRN on 99% of the prescriptions. "IF needed" on narcotics might help but doctors will not write that.