CONTROLLING PAIN: Facing up to the challenge of range orders
Patricia Kelly Rosier MS, RN, ACNS-BC

December 2012 
Volume 42  Number 12
Pages 64 - 65
  PDF Version Available!

RANGE ORDERS ARE DEFINED as medication orders in which the selected dose varies over a prescribed range according to the patient's situation and status.1 Using range orders for analgesia is still a hot topic despite the publication of a consensus statement by the American Society of Pain Management Nurses (ASPMN) and the American Pain Society in 2004.2 According to this statement, an RN "who is competent in pain assessment and analgesic administration can safely interpret and implement properly written 'as needed' or p.r.n. range orders for analgesic administration."2 But when discussing range orders today, many still can't agree about the distinction between prescribing and using nursing judgment. This article discusses how nurses can use range orders safely and effectively.The Joint Commission (TJC) approves of the use of range orders, provided appropriate policies and procedures are in place and nurses are educated in their implementation.1 The TJC standard that applies in this situation is MM.04.01.01: "Medication orders are clear and accurate."3 Nevertheless, questions continue to arise during TJC surveys, such as, "Does this order provide enough direction to the nurse administering the analgesic?" Hospital staff members have questions as policies and procedures are developed and implemented; for example, "How specific must the order be?" In response to queries from hospitals, some state boards of nursing stated that when range orders were used, nurses were going beyond the scope of their license and were actually prescribing.1Nurses have long believed that using range orders gives them flexibility to meet the individualized needs of patients experiencing pain. Nurses at the bedside are in the best position to assess the patient and use their professional judgment about the appropriate analgesic option. Nurses then reassess the interventions they've provided and evaluate the effectiveness of the analgesic plan of care, using the nursing process.Variations in how

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