Nurses’ decision‐making related to administering as needed psychotropic medication to persons with dementia: an empty systematic review

Abstract

Behavioural and psychological symptoms of dementia occur in approximately 75% of people with dementia admitted to acute care. Acute care nurses’ decision‐making regarding administering ‘as needed’ (pro re nata or PRN) psychotropic medications to persons with dementia are not well understood. This is an important clinical concern because ‘as needed’ medications are given at the discretion of the nurse. A comprehensive, systematic search and screen for studies that explored nurses’ decision‐making related to administering as needed psychotropic medication to persons with dementia in acute care settings was conducted. No studies that reported nurses’ decision‐making related to administration of as needed psychotropic medications to hospitalized persons with dementia were identified. In light of this, we present a discussion based on a narrative review of what is known on this topic from other settings, based on papers found in our original review. We will briefly explore what is needed in future research to address the gap in knowledge about nurse’ decision‐making related to administering as needed psychotropic medications.Implications for practiceResearch is needed to understand and inform the decision‐making process in the administration of as needed psychotropic medications to hospitalized persons with dementia.

Challenging Behaviors as a Relational Phenomenon: Findings From a Qualitative Study in a Nursing Home in Norway

“…or "Help me!" It can also be a way of gaining attention and achieving a reaction from the surroundings, which may help counteract a feeling of loneliness and inner emptiness (Selnes, 2003, p. 18, see also Walsh et al, 2021).…”

“…It is important to understand, as Legere et al (2018, p. e1361) remind us, that challenging behaviors “are often normal responses to stress and uncertainty rather than neuropathology.” These behaviors, they continue, “can result from a number of factors related to unmet needs, including individualistic, social and organisational contexts that are not exclusive to dementia.” Another term to describe this phenomenon, therefore, is responsive behaviors (Walsh et al, 2021). A Canadian study found that “poor staffing,” for example, too few care workers on duty, but also a high staff turnover, resulted in rushed and depersonalized care, which, in turn, resulted in an increase in challenging behaviors among residents (Morgan et al, 2008).…”

Administration of pro re nata medications by the nurse to incapacitated patients: An ethical perspective

“…The exact number of medication errors due to PRN medication administration has not been reported in the international literature. PRN medication errors are characterized by not mentioning the reason behind medication administration and ambiguities in steps taken to manage the administration process, as well as to monitor their effects and side effects after administration 25,26 . Coercion in the administration 27 , and over-administration of PRN medications, when medication is not the first choice for treatment 18,28 are quite common.…”

“…PRN medication errors are characterised by not mentioning the reason behind medication administration and ambiguities in steps taken to manage the administration process, as well as to monitor their effects and side effects after administration. 25,26 Coercion in the administration, 27 and over-administration of PRN medications, when medication is not the first choice for treatment 18,28 are quite common. Inappropriate use of PRN medications is associated with polypharmacy and longer stays in nursing homes with a median of 2.1 years.…”

Practical Considerations of PRN Medicines Management: An Integrative Systematic Review

“…Furthermore, the monitoring of PRN medications by nurses after administration and related documentation are not properly performed ( Friedman et al, 2012 ; Ross et al, 2021 ). Making decisions on the use of PRN medications usually is not guideline-based and rather is based on habits and previous experiences in clinical practice ( Douglas-Hall and Whicher, 2015 ; Walsh et al, 2021 ).…”