The administration of psychotropic PRN medication in Scottish psychiatric intensive care units

Abstract

Information concerning the administration of psychotropic PRN medication in Scottish PICUs is scarce. The medical notes and prescription charts of all patients (n = 75) admitted during the study period were consulted to determine the frequency and nature of PRN practice. 65% of patients (n = 49) were administered up to 11 drugs comprising of antipsychotics (n = 8), benzodiazepines (n = 2) and zopiclone. The most frequently administered PRN medicines were lorazepam, haloperidol and zuclopenthixol. The mean dose administered for oral and intramuscular (IM) forms of both lorazepam and haloperidol were very similar. The mean number of PRN administrations per patient per day was 0.4. 40% of psychotropic PRN administrations were initiated by the nurse with the majority of doses administered at bedtime. Ten patients received an IM injection. Four patients were restrained during these administrations. Documentation pertaining to the rationale for IM administrations and of pre and post rapid tranquillisation physical health monitoring was lacking. This study highlights variation in practice between units, inadequate monitoring and documentation, a possible lack of understanding by prescribers of the differences in bioavailability between oral and injectable forms of medication and relatively limited use of newer drugs

Practical Considerations of PRN Medicines Management: An Integrative Systematic Review

“…All studies published in English from 1987 until 2021. Twelve studies were from Australia ( Edwards et al, 2001 ; Geffen et al, 2002 ; Curtis et al, 2007 ; Stein-Parbury et al, 2008 ; Kaur et al, 2009 ; Usher et al, 2009 ; Usher et al, 2010 ; Mullen and Drinkwater, 2011 ; Russell et al, 2014 ; Barr et al, 2018 ; Stasinopoulos et al, 2018 ; Sharma et al, 2021 ), five from the United States ( Gordon et al, 2008 ; Carder, 2012 ; McCarthy et al, 2013 ; McCarthy et al, 2019 ; Procaccini et al, 2020 ), four from Canada ( Craven et al, 1987 ; Swart et al, 2011 ; Martin et al, 2018a ; Walsh et al, 2020 ), three from the United Kingdom ( Di Giulio and Crow, 1997 ; Baker et al, 2007a ; Griffiths et al, 2019 ), two from Saudi Arabia ( Al-Sughayir, 2014 ; Al-Sughayir, 2017 ), one from Germany ( Dörks et al, 2016 ), one from Ireland ( Jimu and Doyle, 2019 ), one from Norway ( Nilsen et al, 2020 ), one from Scotland ( Akram et al, 2014 ), and one from Thailand ( Chaichan, 2008 ).…”

“…Regarding their methods, 11 studies used the chart review method ( Craven et al, 1987 ; Curtis et al, 2007 ; Chaichan, 2008 ; Stein-Parbury et al, 2008 ; Kaur et al, 2009 ; Mullen and Drinkwater, 2011 ; Swart et al, 2011 ; Akram et al, 2014 ; Al-Sughayir, 2014 ; Russell et al, 2014 ; Al-Sughayir, 2017 ), six were cross-sectional ( Di Giulio and Crow, 1997 ; Geffen et al, 2002 ; Gordon et al, 2008 ; Dörks et al, 2016 ; Barr et al, 2018 ; Griffiths et al, 2019 ), six were qualitative ( Usher et al, 2009 ; Usher et al, 2010 ; Carder, 2012 ; Jimu and Doyle, 2019 ; Nilsen et al, 2020 ; Walsh et al, 2020 ), three were interventional ( Edwards et al, 2001 ; McCarthy et al, 2013 ; McCarthy et al, 2019 ), two were secondary analysis ( Stasinopoulos et al, 2018 ; Sharma et al, 2021 ), one was Delphi technique ( Baker et al, 2007a ), one was mixed-methods ( Martin et al, 2018a ), and one was qualitative improvement ( Procaccini et al, 2020 ).…”

Use of Psychotropic “Pro Re Nata” Medications by Patients Attending the Outpatient Clinic in a Hospital: A Qualitative Exploration

“…Self-management of medications by patients depends on their motivation, values and beliefs, trustworthiness with their doctors, and their confidence in medicines prescribed to them (9). Previous studies on self-management of psychotropic PRN medications had been conducted in inpatients (8,(10)(11)(12)(13)(14)(15). These studies revealed that inpatients had a minimal understanding of medications and do not support to use alternatives.…”

Staff perceptions of PRN medication in a residential care setting

“…Psychotropic medication is one of the most frequently used (Akram et al, 2014;Ziguras et al, 1999) forms of treatment in mental healthcare settings. Due to an increasing population and long-term usage, the financial costs have also been increasing (Ilyas and Moncrief, 2012).…”

“…However, the decision to use PRN is a subjective one based on the clinical views of the staff, the views and behaviour of the patient, the organisational policies and the legislation of the country. The National Institute for Health and Care Excellence (NICE, 2014), the Royal Pharmaceutical Society of Great Britain (Royal Pharmaceutical Society, 2007) and the Nursing and Midwifery Council's (NMC) guidelines on medicines management all fall short of providing evidence-based guidance on how staff should make judgements about when psychotropic PRN medication is 'needed'.Psychotropic medication is one of the most frequently used (Akram, Slavin & Davies, 2014;Ziguras et al, 1999) forms of treatment in mental health care settings. Due to an increasing population and long-term usage the financial costs have also been increasing (Ilyas & Moncrieff, 2012).…”