Use of Pro Re Nata Medications in Acute Inpatient Care

Objectives: Available evidence suggests that the use of ‘as needed’ (PRN; from the Latin pro re nata: for an occasion that has arisen) medications has remained a standard aspect of treatment in acute inpatient mental health units over a number of years despite lack of evidence from controlled clinical trials. The practice is one in which doctors and nurses are interdependent; that is, while doctors prescribe the medications, professional nurses are the ones who make the clinical decisions to administer them. The aim of the present study was to provide a detailed description of the circumstances surrounding the use of PRN medications across four inpatient units in Sydney. Methods: The medical records of all patients admitted for >24h during a 2month period were retrospectively audited for details regarding prescriptions and administrations of PRN medications. Results: A total of 420 records were reviewed, producing a total of 3868 PRN medication administrations. Ninety-seven per cent of all patients were prescribed PRN medications and 93.8% were prescribed regular medications. The most frequently prescribed medications were second-generation antipsychotics for regular use along with benzodiazepine for PRN use. Nearly 84% of patients received at least one PRN medication during their admission, while patients diagnosed with personality disorder received more PRNs per day. The most common reason for PRN administration was patient agitation. The results indicated poor documentation in the prescription and documentation of PRN administrations. Also, the findings show that a small subset of the patients (5%) received >30% of all PRN medications. Conclusion: PRN medication use has endured as standard practice and the results of the present study are consistent with the reported frequency of use increasing slightly over the years. The combination of second-generation antipsychotics as regular medications and benzodiazepines for PRN medication is consistent with recommended treatment guidelines. The small subset of patients who were overrepresented in the PRN administrations is noteworthy.

[1]  G. Currier,et al.  Introduction: Methods, Commentary, and Summary , 2005 .

[2]  S. Marder.  A review of agitation in mental illness: treatment guidelines and current therapies. , 2006, The Journal of clinical psychiatry.

[3]  J. Milton,et al.  Hidden high-dose antipsychotic prescribing: effects of p.r.n. doses , 1998 .

[4]  L. Miller,et al.  P.R.N. (As-needed) orders and exposure of psychiatric inpatients to unnecessary psychotropic medications. , 2003, Psychiatric services.

[5]  E. Whicher,et al.  'As required' medication regimens for seriously mentally ill people in hospital. , 2002, The Cochrane database of systematic reviews.

[6]  T. Kudinoff,et al.  Administration of PRN medication: a descriptive study of nursing practice. , 1999, The Australian and New Zealand journal of mental health nursing.

[7]  R. Gray,et al.  Administration of PRN medication by mental health nurses. , 1997, British journal of nursing.

[8]  G. Currier,et al.  The expert consensus guideline series. Treatment of behavioral emergencies 2005. , 2005, Journal of psychiatric practice.

[9]  M. Bowden.  Audit: prescription of ‘as required’ (p.r.n.) medication in an in-patient setting , 1999 .

[10]  P. Taylor,et al.  A Study of Psychotropic Medication Given ‘As Required’ in a Regional Secure Unit , 1990, British Journal of Psychiatry.

[11]  R. Walker.  PRN psychotropic drug use on a psychiatric unit , 2005, Psychiatric Quarterly.

[12]  P. Voore,et al.  PRN Medication for Psychiatric Inpatients * , 1987, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[13]  M. Roberts,et al.  Pro Re Nata Medication for Psychoses: An Audit of Practice in Two Metropolitan Hospitals , 2002, The Australian and New Zealand journal of psychiatry.

[14]  K. Usher,et al.  Mental health nurses' PRN psychotropic medication administration practices. , 2001, Journal of psychiatric and mental health nursing.

[15]  P. Baumann,et al.  Psychotropic Drug Prescription in a Psychiatric University Hospital , 1999, Pharmacopsychiatry.

[16]  T. Craig,et al.  An epidemiologic study of prn/stat medication use in a state psychiatric hospital. , 1995, Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists.

[17]  Janette Curtis,et al.  Administration of 'as needed' psychotropic medication: a retrospective study. , 2003, International journal of mental health nursing.

[18]  B. Jackson,et al.  As-needed psychotropic medications: prevalence, indications, and results. , 1994, Journal of psychosocial nursing and mental health services.

[19]  D. Donat.  Encouraging alternatives to seclusion, restraint, and reliance on PRN drugs in a public psychiatric hospital. , 2005, Psychiatric services.

[20]  Schizophrenia: From Neuroimaging to Neuroscience , 2006 .

[21]  M. Roberts,et al.  Pro Re Nata Medication for Psychoses: The Knowledge and Beliefs of Doctors and Nurses , 2002, The Australian and New Zealand journal of psychiatry.

[22]  T. Trauer,et al.  P.r.n. medication use in a psychiatric high-dependency unit following the introduction of a nurse-led activity programme. , 2006, International journal of mental health nursing.