PRN Medication Administration in a Geriatric Psychiatric Hospital: Chart Review and Nursing Perspective

Abstract

It would be worthwhile to train all staff in a patient-centered or ecopsychosocial (i.e., non-pharmacological) model of care, which would provide staff alternatives to PRNs. In that context, it would be important to implement standards of practice into geriatric psychiatry inpatient settings for PRN administration and documentation.

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

“…PRN medications are often ordered with a dose range and more than one route (e.g. oral, intramuscular [IM]), enabling nurses to determine the dosage, route, and the time of administration (Harper et al, 2017; Neumann et al, 2015). Therefore, the decision to administer a PRN is at the individual nurse's discretion (Hynninen et al, 2014; Neumann et al, 2015).…”

PRN Medicines Management for Psychotropic Medicines in Long-Term Care Settings: A Systematic Review

“…However, in general, behaviours indicating the need for PRN medication administration were not clearly and specifically described. Additionally, it is unclear whether PRN administration is commenced by the nurse, the resident, or the family [52]. Prescription and administration of PRN psychotropic medications should not expose patients to the feelings of inferiority and coercion [3].…”

“…This is a general mandate for healthcare systems to devise and implement comprehensive national medicine policies to ensure safe and reliable medication prescription and administration [53], and to balance the risk and benefits of medications among residents [54]. However, there are often inconsistencies between prescription notes and administration records, which can overshadow attempts to assess the effectiveness of PRNs, due to a lack of data on the effect of PRNs on patients' outcomes [52]. For example, there are different perceptions and opinions amongst physicians that prescribe, and nurses that administer, PRN medication [4,55].…”

“…The improvement of PRN prescription practice and promotion of PRN prescription and administration requires changes in the healthcare policies of patient safety in care homes [27,58,59], including the mandate of formalised, systematic checking of residents for potential ADRs [47,48]. The implementation of system-level standards of practice for PRN administration, impact assessment, and documentation can help to improve overall patient safety in care homes [52]. Accountability for the administration of PRN medications can be improved by educating nurses in terms of vigilance over indications, reasons for use, medication effects and side effects, regular checking of prescribed medications, and continuous monitoring so as to avoid high dose medication and polypharmacy to ensure efficacy and prevent harm [9,[60][61][62][63].…”

Enhancing Person-Centered Care in Long-Term Care

“…Harper and colleagues address an issue that has long been neglected in LTC settings, i.e., the use of PRN medications (Harper, Reddon, Hunt, & Royan, 2017). Conducting chart reviews and interviews of nurses in two units of a geriatric psychiatric hospital, the authors clearly show how documentation of the behaviors targeted and the rationales employed for PRN usage were "sub-optimal."…”