Descriptive analysis of pro re nata medication use at a Canadian psychiatric hospital

Abstract

Pro re nata (PRN), a Latin phrase meaning 'as needed', is used to describe medications that might be used in specific situations, in addition to regularly-scheduled medications, such as when a patient is particularly anxious, experiencing insomnia, or suffering pain. While helpful in some circumstances, PRN are associated with an increased risk of morbidity, overuse, dependence, and polypharmacy. There is also a dearth of medical literature describing current practices and trends of PRN administration in mental health facilities, especially in Canada, and the literature that does exist is limited by poor documentation practices. Therefore, the primary objective of the current study was to understand the reason (purpose), frequency, use, documentation practices, and outcome (i.e. effectiveness, side-effects) of PRN medication use on inpatient units. Data were pulled to capture a snapshot of PRN administrations over a 3-month period, and included information related to the administration of the PRN medication, such as time of administration, type and dose of PRN medication, and prescribed indication, as well as patient-specific information. Results indicated that approximately 8200 psychotropic PRN medications were administered during the designated 3-month time period, and over 90% of patients received at least one PRN. Most of these were benzodiazepines, followed by antipsychotics. Further analyses were conducted to determine other characteristics of PRN use patterns and to provide a baseline of understanding that will inform future research to investigate the practice of PRN administration to psychiatric inpatients.

Analysis of non‐pharmacological interventions attempted prior to pro re nata medication use

“…effectiveness, side‐effects) of PRN medication use on all inpatient units at our hospital, readers are directed to our previous publication (see Martin et al . ). In general, our snapshot revealed that 91% of inpatients received at least one PRN, there was a small group of patients who received the majority of the PRN medications (15% of patients received 70% of the medication), and benzodiazepines made up the majority of the PRN administered (52%).…”

“…The present study is a quantitative design with a retrospective chart review that was approved by our local research ethics board and was part of a larger study, a portion of which, including the methodology, was previously published in this journal (Martin et al . ). Briefly, we initially identified all psychotropic PRN administrations between 1 June 2015 and 31 August 2015 across all inpatient units.…”

“…effectiveness, side‐effects) of PRN medication use on all inpatient units at our hospital (Martin et al . ). In this secondary investigation, we aimed to understand what happens prior to nursing staff administering PRN medication, and determine the extent to which non‐pharmacological interventions are part of this practice.…”

Staff and patient accounts of PRN medication administration and non‐pharmacological interventions for anxiety

“…; Martin et al . ). The most common indications for this medication are agitation, anxiety, and insomnia (e.g.…”

“…; Martin et al . ; Srivastava ). Other reasons psychotropic PRN medications are administered include verbal aggression, irritableness, intrusiveness, refusal to cooperate, refusal of scheduled medication, restlessness, and as requested by the patient (e.g.…”