Practical Considerations of PRN Medicines Management: An Integrative Systematic Review

Abstract

Background and objectives: Highly widespread use of pro re nata (PRN) medicines in various healthcare settings is a potential area for improper medication prescription and administration leading to patient harm. This study aimed to summarize and integrate the findings of all relevant individual studies regarding the practical considerations of PRN medicines management including strategies and interventions by healthcare professionals for safe prescription, dispensing, administration, monitoring, and deprescription of PRN medicines in healthcare settings.Methods: An integrative systematic review on international databases were performed. Electronic databases including Web of Knowledge, Scopus, PubMed (including MEDLINE), and Cinahl were searched to retrieve articles published until end of May 2021. Original qualitative, quantitative, and mixed methods studies written in English were included with a focus on PRN medicines management in healthcare settings. Research synthesis using the narrative method was performed to summarise the results of included studies.Results: Thirty-one studies on PRN medicines in healthcare settings by different healthcare providers were included after the screening of the databases based on eligibility criteria. They were published from 1987 to 2021. The majority of studies were from Australia, the United States, Canada, and the United Kingdom and were conducted in psychiatric settings. Given variations in their purposes, methods, and outcomes, the research synthesis was conducted narratively based on diversities and similarities in findings. Eight categories were developed by the authors as follows: “PRN indications and precautionary measures,” “requirements of PRN prescription,” “interventions for PRN administration,” “monitoring and follow up interventions,” “deprescription strategies,” “healthcare professionals’ role,” “participation of patients and families,” and “multidisciplinary collaboration.” Each category consists of several items and describes what factors should be considered by healthcare professionals for PRN medicines management.Conclusion: The review findings provide insights on the practical considerations of PRN medicines management in clinical practice. The suggested list of considerations in our review can be used by healthcare professionals for optimal PRN medicines management and safeguarding patient care.

Surviving surgery; succumbing to pharmacotherapy: A case report underscoring the importance of PRN order clarification for patient safety

“…As such, policies and interventions for their safe prescription, dispensing, administration, monitoring, and de‐prescription are necessary, especially when supervising PRN orders in various health care settings 4 . Adelaide 15 et al, and Mardani 4 et al, defined standards for the prescription of PRN medicines to include the use of generic drug names, clarification of indications for appropriate use, indicating maximum daily dose, the minimum interval needed between doses, duration of use, and providing necessary safety alerts. It should also be noted that continued educational programs and activities regarding the aforementioned practices for physicians, pharmacists, nurses, patients, and their caregivers are crucial in reducing medication errors due to PRN orders 4,7,16 …”

“…Adelaide 15 et al, and Mardani 4 et al, defined standards for the prescription of PRN medicines to include the use of generic drug names, clarification of indications for appropriate use, indicating maximum daily dose, the minimum interval needed between doses, duration of use, and providing necessary safety alerts. It should also be noted that continued educational programs and activities regarding the aforementioned practices for physicians, pharmacists, nurses, patients, and their caregivers are crucial in reducing medication errors due to PRN orders 4,7,16 …”

“…It should also be noted that continued educational programs and activities regarding the aforementioned practices for physicians, pharmacists, nurses, patients, and their caregivers are crucial in reducing medication errors due to PRN orders. 4,7,16 Importantly, the Pharmacy and Therapeutics (P&T) Committee plays a crucial role in devising institutional guidelines related to the safe and therapeutic use of drugs. The P&T Committee not only evaluates, educates and advises the medical staff and administration/management in all matters related to the use of medications, but is also responsible for overseeing policies and procedures pertaining to all aspects of medication use.…”

“…PRN prescribing aims to complement scheduled drugs, empowering health care providers – including physicians, pharmacists, and nurses – as well as patients by providing flexibility and latitude in managing specific physical and mental conditions/disorders 2,3 . Common PRN medicines include analgesics, psycholeptics and psychotropics, and gastrointestinal medicines 1,4 …”

“…2,3 Common PRN medicines include analgesics, psycholeptics and psychotropics, and gastrointestinal medicines. 1,4 However, PRN medicines contribute to a significant portion of medication errors. 3 In a 2019 study, the prevalence/rate of medication errors among PRN orders was reported as approximately 77% in outpatient clinics.…”