Title: Fast Fact and Concept #70: PRN Range analgesic orders
Author(s): Deb B. Gordon; David E. Weissman
PRN range orders (e.g. 2-6 mg IV morphine Q2h PRN) are designed to provide flexibility in dosing to meet an individual's unique analgesic needs. However, range orders have been shown to be a source of medication errors. It is critical that physicians, nurses, and pharmacists share a common understanding of how to implement PRN range orders and that they demonstrate consistency in this interpretation.
Reasonable range--range orders must be large enough to provide appropriate options for dose titration, but small enough so that appropriate reassessment is done in a timely manner. A good rule is that a range order should be in the range of 100-200% of the base dose (2 - 6 mg).
Initial dose selection--for the opioid naïve patient, the first dose administered should be the lowest dose in the range; if the patient is opioid tolerant, or has received recent doses with inadequate pain relief and tolerable side effects, a dose on the higher end of the range can be administered.
Dose escalation--for moderate to severe pain increase the dose by 50-100%; for mild pain (fine tuning) increase by 25%. Do not increase a prn the dose by > 100% at one time; e.g. increasing from 2-4 mg is a 100% dose increase; from 2-6 mg is a 200% dose increase. Be knowledgeable about the onset, peak, and duration of the specific opioid ordered. Doses of short acting opioids can be increased at subsequent dosing intervals (Q 1-2 hours) while long acting opioid products should be increased no more frequently than every 24-72 hours depending on the specific product.
References: Debra B. Gordon, RN. Adapted with permission from: Pain Management Fast Facts- 5 Minute Inservice. UWisconsin Hospital and Clinics. Weissman DE, Ambuel B and Hallenbeck J. Improving End-of-Life Care: A resource guide for physician education. Medical College of Wisconsin, 2002. Handbook of Cancer Pain Management.Wisconsin Cancer Pain Initiative, 5th Edition.1996.
Copyright and Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Citation for Fast Facts and Concepts #70 PRN Range Analgesic Orders. Gordon DB and Weissman DE. June 2002 End-of-Life Physician Education Resource Center www.eperc.mcw.edu.
Fast Facts and Concepts was originally developed as an end-of-life teaching tool by Eric Warm, MD, U. Cincinnati, Department of Medicine. See: Warm, E. Improving EOL care--internal medicine curriculum project. J Pall Med 1999; 2: 339-340.
Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.
Creation Date: 6/2002
Purpose: Instructional Aid, Self-Study Guide, Teaching
|Training: Fellows, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice|
|Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery|
ACGME Competencies: Medical Knowledge, Patient Care
Keyword(s): Addiction, Chronic non-malignant pain, Controlled substance regulations, Pain, Pain assessment, Pain treatment
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