Risk Management, Proctology Consulted After RN Confuses PRN and PR Orders

CRESTED BUTTE, CO – In what’s being labeled “an unfortunate incident that we’re all trying to get behind us,” St. Indignant’s Hospital administrator Paul McManus revealed that an investigation is underway after a new grad RN was discovered to be consistently mistaking PRN and PR orders.

The issue was brought to light by med/surg charge nurse Nikki Cranny after observing new grad RN Sarah Simplayton over the course of her first few weeks of employment.  “It seemed curious to me that I rarely saw Sarah grab a cup of water when pulling PRN meds from the Pyxis,” Cranny noted, “but I didn’t think much of it – I figured that the patients had bottles of water in their rooms.”

The mystery deepened when RN Cranny received multiple messages from central supply that her unit was using an inordinate amount of enema bags and individual lubricant packets.  “I’m sorry to say I fooled myself.  I figured that we’ve had our fair share of constipated patients and sometimes staff uses the Vaseline packets for dry lips and cracked cuticles, I don’t think I was ready for the truth.”

However, the issue was blown wide open last Thursday night when RN Cranny received a call from room 626 to grab an orange juice and assist Nurse Simplayton with a “snack/juice PRN for borderline low BGL” order on a patient with a BGL of 64 mg/dl.

“What I saw, I’m going to have a hard time forgetting that.  The patient was alert though lethargic, twisted on the bed with legs akimbo.  Nurse Simplayton was sort of pouring the first bottle of orange juice into the patient’s bottom, sweat beading on both of their brows. The whole scene has continued to haunt me,” Cranny recalls in horror.

Fortunately, an audit of Simplayton’s patients has shown no evidence of her impromptu rectal wrangling as the proximate cause of any discernible injury or poor outcome.  In fact, hospital administrators were stunned to discover that her survey scores were higher than the majority of other nurses on the floor.  Administrator McManus explains, “We’re not sure if the patients just feel more intimately involved with their caregiver or what, but we’re adding an ‘activity as tolerated, PR’ order to our admission bundle order set.”