Rates of PRN Medication Administration in Australian Residential Aged Care

Abstract

Objective: To investigate administration of pro re nata (PRN) medications and nurse-initiated medications (NIMs) in Australian aged care services over a 12-month period. Design: Twelve-month longitudinal audit of medication administrations. Setting and participants: Three hundred ninety-two residents of 10 aged care services in regional Victoria, Australia. Methods: Records of PRN and NIM administration were extracted from electronic and hard copy medication charts. Descriptive statistics were used to calculate medication administration per person-month. Poisson regression was used to estimate predictors of PRN administration. Results: Over a median follow-up of 12 months (interquartile range 10e12 months), 93% of residents were administered a PRN medication and 41% of residents an NIM on 21,147 and 552 occasions, respectively. The mean number of any PRN administration was 5.85 per person-month. The most frequently administered PRN medications per person-month were opioids 1.54, laxatives 0.96, benzodiazepines 0.72, antipsychotics 0.48, paracetamol 0.46, and topical preparations 0.42. Three-quarters of residents prescribed a PRN opioid or PRN benzodiazepine and two-thirds of residents prescribed a PRN antipsychotic had the medication administered on 1 or more occasions over the follow-up. Conclusions and Implications: Most residents were administered PRN medications. Administration was in line with Australian regulations and institutional protocols. However, the high frequency of PRN analgesic, laxative, and psychotropic medication administration highlights the need for regular clinical review to ensure ongoing safe and appropriate use.Ó 2020 AMDA e The Society for Post-Acute and Long-Term Care Medicine.Medication management is an increasingly complex and important component of quality care in residential aged care services (RACS). 1 Australian RACS are synonymous with long-term care facilities and nursing homes in other countries and provide permanent and respite accommodation for people who require access to 24-hour care that can no longer be provided in their own homes. 1 A review of the international literature suggests that up to 74% of residents take 9 or more regular medications, 2 with most residents dependent on staff for medication administration. Up to 94% of residents are prescribed pro re nata (PRN) or "as-needed" medications. 3 PRN medications are prescribed by the resident's physician and administered by nurses, or in some situations by care workers, on an as-needed basis. 4 Previous Australian and German research suggests residents are prescribed up to 4 PRN medications, 5e7 with analgesics and laxatives most frequently administered. 3 In addition to administering PRN medications, Australian guidelines permit registered nurses to initiate specific over-the-counter BA and LMC are employed by health services overseen by the Department of Health and Human Services.

Transforming routinely collected residential aged care provider data into timely information: Current and future directions

“…9 Similarly, recent research using electronic administration data identified a more than 3-fold variation in rate of PRN administration per resident-month across 10 aged care homes operated by the same provider. 16 Reducing the current siloed nature of the different administrative data sets from the same aged care provider by merging them together delivers further useful information to support decision-making and quality improvement programs specific to an aged care organisation, home or individual. For example, linking health conditions documented in one part of the information system to the eMAR through unique identifiers allows an assessment of the use of medication for specific conditions and enables risk adjustment.…”

PRN Medicines Management for Older People with Long-Term Mental Health Disorders in Home Care

“…26,27 It is commonly used for various types of medications to relieve patients' physical and psychological suffering. Besides acetaminophen and opioids for pain relief, 28 psychotropic and psycholeptic medications are more commonly prescribed and administered as PRN to older patients with long-term mental health conditions, [29][30][31][32] but the clinical effectiveness of this style of medication use in comparison with other prescription and administration styles of medication has remained unexplored and needs further research. 33 Inappropriate use of PRN medications can extend the duration of hospitalisation in long-term healthcare settings and hinder the smooth transition of care for older people with chronic health conditions to their own home.…”

Medications in Post-Acute and Long-Term Care: Challenges and Controversies

“…52 A related controversial area is how much to encourage or discourage pro re nata (PRN) administration in residential long-term care settings, which is discussed in the context of results of a multifacility survey conducted in Australia. 53 With the COVID-19 pandemic having particularly devastating effects in long-term care communities, a particularly urgent emerging need is to better understand whether and how to effectively treat early COVID-19 infection in older persons, to prevent disease progression and reduce the probability of long-term consequences. 54 Initial enthusiasm for hydroxychloroquine and azithromycin has waned, but reports continue on other agents, including one in this month's JAMDA on metformin.…”