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

Abstract

Many medications are prescribed and administered PRN (pro re nata, as needed). However, there are few integrative reviews to inform PRN psychotropic medication use in long-term care facilities and nursing or care homes. Accordingly, this integrative systematic review aimed to improve our understanding of PRN medicines management with a focus on psychotropic medications (antipsychotics, sedatives, anxiolytics, and hypnotics) in long-term care settings. Keywords relating to PRN in English, Norwegian, and Spanish were used, and articles published between 2009 and 2019 were retrieved. Based on the inclusion criteria, eight articles were used for data analysis and synthesis. This review offers a description of PRN prescription and administration of psychotropic medications in long-term care. Variations were observed in the management of PRN psychotropic medications based on residents’ underlying health conditions and needs, duration of use, and changes between medications and doses. Neither the reasons for PRN prescription and administration nor the steps taken to identify and manage any associated adverse reactions or adverse drug events were reported. Further initiatives are needed to improve PRN medicines management to explore factors that affect PRN prescription and administration and to develop appropriate PRN guidelines to prevent harm and improve the safety of people living in long-term care facilities.

PRN Medicines Optimization and Nurse Education

“…A study in the UK showed that 5796 medication errors happened over four data collection periods during 2014 and 2015 in various hospital wards [ 26 ]. Medication errors also occur frequently in long-term care, often due to lack of knowledge and competence, under-reporting of medication errors, confusion between trade-name products vs. generics, and work routines [ 27 , 28 ]. According to the results of a systematic review, 16–27% of nursing homes’ residents experienced medication errors.…”

“…PRN medicines management is a crucial instrument in guiding the involvement of nurses working in a range of healthcare units, by which patients’ physical and mental sufferings are relieved based on nurses’ decision-making [ 28 ]. As front line staff in healthcare settings, nurses are located in the best position to systematically monitor patients’ needs, use their knowledge and skills and apply their authority regarding medication practice for making appropriate decisions on medicines management [ 40 , 41 ].…”

Looking for the “Little Things”: A Multi-Disciplinary Approach to Medicines Monitoring for Older People Using the ADRe Resource

“…Drug-induced signs and symptoms are difficult to distinguish from underlying disease conditions, often leading to further prescriptions and increasing the risk of drug interactions [ 23 , 24 ]. Prescribing depends almost exclusively on the actions of medical professionals, but systematic monitoring to check for ADRs rarely occurs [ 25 , 26 , 27 , 28 ], and there is no generally-accepted tool for safeguarding patients from under- or over-prescribing [ 29 ].…”

Kan organisering av omsorgsboliger for eldre påvirke praksis i forbindelse med legemidler som gis ved behov?

“…Helsepersonell har mange ulike informasjonsstrukturer å forholde seg til, noe som kan vaere utfordrende i beslutningstakingen omkring administrasjon av behovsmedisin for en beboer, og der man gjerne også har knapt med tid. En oversiktsstudie om håndtering av psykotropiske behovsmedisiner fant at dokumentasjon omkring forskrivning, administrasjon, effekt og bivirkninger var mangelfull (Vaismoradi et al, 2019). Separate legemiddellister kan vaere et hinder for kvaliteten i helsetjenesten (Murray, 2017).…”

“…Pasienter som får hjelp med administrering av sine legemidler, inklusive behovsmedisin, er avhengig av at helsepersonellet aksepterer en forespørsel og/eller gjør vurderinger som er nødvendige for å administrere legemiddelet (Stokes, Purdie & Roberts, 2004). Studier fra sykehjem har vist at behovsmedisinering kan ha sammenheng med flere forhold knyttet til pasienten, for eksempel pasientens hjelpebehov knyttet til aktiviteter i dagliglivet (Stasinopoulos et al, 2018), pasientens alder og kognitive status (Dörks, Schmiemann & Hoffmann, 2016), atferd og behov (Vaismoradi, Vizcaya Moreno, Sletvold & Jordan, 2019), nylig sykehusinnleggelse (Stokes et al, 2004), antall faste medikamenter pasienter står på, og hvor lenge pasienten bor på sykehjemmet (Dörks et al, 2016). Det er også rapportert at behovsmedisinering kan påvirkes av forhold knyttet til helsepersonellet og organisasjonen, for eksempel ansattes utdanning og erfaring (Westbury et al, 2018), holdninger til laering (Murray, 2017), hvilken fagperson som er på arbeid (Johansson-Pajala, Jorsäter Blomgren, Bastholm-Rahmner, Fastbom & Martin, 2016), lederens lederstil samt institusjonens miljø og fasiliteter (Murray, 2017) og hvilket sykehjem pasienten bor på (Stokes et al, 2004).…”