An effective method of handling PRN orders to reduce labor and improve efficiency

Rex Hospital, Raleigh, NC, found its method of PRN (unit dose) medication delivery to be time consuming, labor intensive, and repetitive. Thus, it was decided to evaluate this system and to find a more efficient method of PRN delivery. A 24 hour supply of unit dose medication is delivered daily using a cart exchange system at this hospital. Three approaches were used to reduce the handling of PRN medications: (1) Removing all PRN orders of Milk of Magnesia, cascara, and mineral oil from the patient drawer. These three medications are now floor stock items at each nursing station; (2) Removing all PRN orders of 325 mg aspirin and acetaminophen tablets, 600 mg aspirin, and 650 mg acetaminophen suppositories. These items are now kept at the nurses station as a "no charge" floor stock item; and (3) Using zip-lock bags for all other non-controlled PRN medication orders. A 48 hour supply of medication is sent upon receipt of the original order, and not filled again until the empty bag is returned to the pharmacy. The plastic bag is identified by a computer generated label containing the patient's name, room number, and medication identification. The patient medication drawer is divided into two areas, one for storing standing medication orders and one for PRN orders. A time study showed a 40% improvement in cart filling time. The 48 hour supply of PRN medications rarely need refilling. Milk of Magnesia, cascara, and mineral oil PRN orders are often ordered, but seldom used. Thus, floor stocking these items has not been a problem. Floor stocking aspirin and acetaminophen as no charge items has been very successful. All medication orders, including aspirin, acetaminophen, Milk of Magnesia, and so forth are entered onto the patient's medication profile even though they are not sent from the pharmacy. Drug allergies or drug-drug interactions can be detected by reviewing the patient profile when the original order is entered onto the profile. Nursing is very pleased with the divided patient medication drawers and has had no problem with turn around time using PRN bags.