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Journal articles on the topic 'Pro re nata medication'

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Published: 10 December 2022

Last updated: 28 January 2023

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1

Geffen, Josh, Lene Sorensen, Julie Stokes, Allison Cameron, Michael S. Roberts, and Laurence Geffen. "Pro Re Nata Medication for Psychoses: An Audit of Practice in Two Metropolitan Hospitals." Australian & New Zealand Journal of Psychiatry 36, no. 5 (October 2002): 649–56. http://dx.doi.org/10.1046/j.1440-1614.2002.01069.x.

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Objective: To examine the use of pro re nata (PRN) (as needed) medication in hospitalized patients with psychotic disorders. Methods: Retrospective chart reviews were conducted at two large public psychiatry units situated in inner city general hospitals. Pro re nata medication prescription, administration and outcomes were examined during inpatient episodes of care for 184 consecutive admissions of patients diagnosed with a psychotic disorder. Patient demographics, diagnoses, and regularly prescribed medication were also recorded. All admissions were drawn from a threemonth period from December 1998–February 1999. Results: The most prevalent diagnoses were schizophrenia related disorders (n = 111) and mania (n = 34). Substance use disorders (n = 49) were the most common comorbid disorders. Pro re nata medication was administered during the acute phase of 82% of admissions. Drugs prescribed Pro re nata were mostly typical antipsychotics, benzodiazepines and/or anticholinergics. Coprescription of typical antipsychotics PRN with regularly scheduled atypical antipsychotics was common (64%). Pro re nata medications accounted for 31% of the total antipsychotic dose and 28% of the total anxiolytic dose administered during acute treatment. Higher daily doses of PRN medication were given to manic patients, males, younger patients and those with substance use disorders. Pro re nata prescriptions usually specified a maximum daily dose (87%) but rarely gave indications for use (6%). Administration records frequently lacked a specified reason for use (48%) or a notation of outcome (64%). Unit staff noted medication-related morbidity in 37% of patients receiving PRN medication, compared to 3% of patients receiving only regularly scheduled medication. Extrapyramidal symptoms (EPS) were most frequently associated with administration of PRN haloperidol (Relative Risk vs other PRN medications = 5.61, 95% CI = 2.36–13.73). Conclusions: Pro re nata medications comprised a significant part of the treatment which psychotic patients received. The common practice of coprescribing PRN typical antipsychotics with scheduled atypical antipsychotics is potentially problematical since administration of PRN medication is associated with significant medication related morbidity. Preferential use of benzodiazepines as PRN agents may minimize this morbidity and foster subsequent compliance with regularly prescribed antipsychotics.

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2

Carder, Paula, Sheryl Zimmerman, Christopher Wretman, Sarah Dys, and Philip Sloane. "Pro Re Nata Use of Psychotropic Medications in Assisted Living." Innovation in Aging 4, Supplement_1 (December 1, 2020): 706. http://dx.doi.org/10.1093/geroni/igaa057.2482.

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Abstract This study examined the use of pro re nata (PRN, or as needed) psychotropic medications among assisted living (AL) residents. We examined prescriptions and administrations, and compared use based on dementia diagnosis. Data sources included interviews with administrators of 250 AL communities in 7 states and medication administration record review for the prior 7 days; analyses were weighted to the entire state. The percent of all residents prescribed a PRN psychotropic medication was 10.3%. However, residents with a dementia diagnosis were twice as likely to have a PRN psychotropic prescription (15.2% versus 7.2%; p<.001). The majority of psychotropic medications prescribed and administered were for anxiolytics/hypnotics rather than antipsychotics. Additional resident-level factors significantly associated with higher PRN prescribing included psychiatric diagnosis, incontinence, hospice use, confusion/disorientation, and agitation. We summarize these and other findings in the context of state regulatory requirements for staffing, chemical restraints, and dementia care.

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3

Joshi, Priyadarshan, and J. D. Collins. "Pro re nata medication: a risk factor for suicide." Psychiatric Bulletin 19, no. 8 (August 1995): 520. http://dx.doi.org/10.1192/pb.19.8.520.

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4

Nilsen, Marianne Kollerøs, Bodil H. Blix, Hege Sletvold, and Rose Mari Olsen. "Older Adults Living in Sheltered Housing’s Experiences of Involvement in Pro Re Nata Decisions. A Narrative Positioning Analysis." Global Qualitative Nursing Research 8 (January 2021): 233339362110569. http://dx.doi.org/10.1177/23333936211056930.

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Decisions regarding pro re nata medications might be challenging due to the complex nature of the practice. The aim of this study was to expand our understanding of the experiences of older people living in sheltered housings with regard to shared decision-making concerning pro re nata medications. In this study, we conducted in-depth interviews with residents living in Norwegian sheltered housings. The analysis was inductive, based on a narrative positioning analysis. Twelve residents were interviewed, and three narratives representing participants’ variation are presented. People take different positions in shared decision-making of pro re nata medication, and they position themselves variously at different levels and situations. Prevailing master narratives affect the residents’ positions in shared decision-making. Contrasts in older adults’ experiences indicate that shared decision-making is not straightforward and is highly reliant on the context. Seemingly, they wish to be involved and not involved at the same time, a contradiction that healthcare providers need to consider.

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5

Hilton, Michael F., and Harvey A. Whiteford. "Pro Re Nata Medication for Psychiatric Inpatients: Time to Act." Australian & New Zealand Journal of Psychiatry 42, no. 7 (January 2008): 555–64. http://dx.doi.org/10.1080/00048670802119804.

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6

Geffen, Josh, Allison Cameron, Lene Sorensen, Julie Stokes, Michael S. Roberts, and Laurence Geffen. "Pro Re Nata Medication for Psychoses: The Knowledge and Beliefs of Doctors and Nurses." Australian & New Zealand Journal of Psychiatry 36, no. 5 (October 2002): 642–48. http://dx.doi.org/10.1046/j.1440-1614.2002.01068.x.

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Objective: To examine the knowledge and beliefs of doctors and nurses in inpatient psychiatric units about pro re nata (PRN) (as needed) medications for psychotic disorders. Methods: Medical (n = 44) and nursing (n = 80) staff in two metropolitan public hospital units completed a structured questionnaire about their use of PRN psychotropic medications on one occasion during the four months from March–June 1999. Results: Nurses selected more indications for PRN antipsychotics than doctors (3.49 vs 2.72, p < 0.05), whereas doctors selected more indications for PRN benzodiazepines (3.77 vs 3.19, p < 0.05). The groups did not differ in the number of selected indications for using anticholinergics. For agitation, the majority of nurses viewed both benzodiazepines (56%) and antipsychotics (86%) as effective, with 60% preferring an antipsychotic. For the acute control of psychotic symptoms, 99% of nurses believed antipsychotics were effective and 58% benzodiazepines, with 87% preferring an antipsychotic. A large majority of doctors viewed both PRN benzodiazepines, 94%, and antipsychotics, 81%, as effective for agitation, and 55% preferred to use a benzodiazepine. For psychotic symptoms, 80% believed PRN antipsychotics were effective, but only 32% viewed benzodiazepines as effective, and 64% preferred to use an antipsychotic. Nursing staff identified more non-pharmacological techniques for managing both agitation and psychotic symptoms and reported using these more often than doctors. Junior staff, both nursing and medical, had less knowledge of nonpharmacological alternatives to PRN medication than senior staff. Conclusions: Disparities existed between doctors and nurses views on the indications for PRN medication in the acute management of psychoses, thus it is important for doctors to specify indications when writing PRN prescriptions. Despite evidence for the safety and effectiveness of benzodiazepines, there was widespread reluctance to use them as PRN medication in acute psychoses. Beliefs of some staff about PRN medications were at odds with the known properties of these medicines. Educational interventions for both nurses and doctors are required to achieve best practice in PRN medication.

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Mohandas, Rajesh, Gajapathiraju Chamarthi, Shahab Bozorgmehri, Jeremy Carlson, Tezcan Ozrazgat-Baslanti, Rupam Ruchi, Ashutosh Shukla, et al. "Pro Re Nata Antihypertensive Medications and Adverse Outcomes in Hospitalized Patients: A Propensity-Matched Cohort Study." Hypertension 78, no. 2 (August 2021): 516–24. http://dx.doi.org/10.1161/hypertensionaha.121.17279.

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Physicians routinely order blood pressure (BP) medications on an as needed basis or pro re nata to control BPs in hospitalized patients. We hypothesized that treatment of inpatients, who do not have a hypertensive emergency, with the use of antihypertensive medication on an as needed basis could lead to adverse outcomes. Four thousand two hundred nineteen patients who received BP medications on an as needed basis in addition to scheduled antihypertensive medications were matched 1:1 using propensity matching to those who received only scheduled BP medications. Compared with the propensity-matched cohort, patients who received antihypertensive medications on an as needed basis were more likely to experience abrupt lowering of systolic BPs (odds ratio, 2.05 [95% CI, 1.56–2.71], P <0.001), acute kidney injury (odds ratio, 1.24 [95% CI, 1.09–1.42], P =0.002), and ischemic stroke (odds ratio, 8.5 [95% CI, 1.96–36.79]; P <0.001). The use of as needed antihypertensive medication was also associated with increased in-hospital mortality (odds ratio, 2.36 [95% CI, 1.26–4.41]; P =0.001) and an increase in the median length of stay (4.7 versus 2.9 days; P <0.001). In addition, ischemic events were more likely in those who had an abrupt drop in BPs, and the risk was increased in proportion to the number of doses of as needed BP medications administered. The use of as needed antihypertensive medication is associated with an abrupt drop in BPs, increased risk of ischemic events, in-hospital mortality, and longer length of stay. We suggest that the routine use of as needed antihypertensive medication should be discouraged.

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Carlson, Gabrielle A., Lauren Spring, and Joseph E. Schwartz. "Does Pro Re Nata Oral Medication Shorten Outburst Duration in Children?" Journal of the American Academy of Child & Adolescent Psychiatry 61, no. 2 (February 2022): 111–14. http://dx.doi.org/10.1016/j.jaac.2021.09.415.

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Saito, Ema, Stephanie Eng, Christine Grosso, Zeynep Ozinci, and Anna Van Meter. "Pro Re Nata Medication Use in Acute Care Adolescent Psychiatric Unit." Journal of Child and Adolescent Psychopharmacology 30, no. 4 (May 1, 2020): 250–60. http://dx.doi.org/10.1089/cap.2019.0131.

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10

Reddy, H. "Audit of prescribing of PRN (pro re nata) medications." European Psychiatry 23 (April 2008): S342—S343. http://dx.doi.org/10.1016/j.eurpsy.2008.01.1184.

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11

Stewart, Duncan, Deborah Robson, Robert Chaplin, Alan Quirk, and Len Bowers. "Behavioural antecedents to pro re nata psychotropic medication administration on acute psychiatric wards." International Journal of Mental Health Nursing 21, no. 6 (August 1, 2012): 540–49. http://dx.doi.org/10.1111/j.1447-0349.2012.00834.x.

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12

Martin, Krystle, Vinita Arora, Ilan Fischler, and Renee Tremblay. "Descriptive analysis of pro re nata medication use at a Canadian psychiatric hospital." International Journal of Mental Health Nursing 26, no. 4 (November 2, 2016): 402–8. http://dx.doi.org/10.1111/inm.12265.

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13

Martin, Krystle, Vinita Arora, Ilan Fischler, and Renee Tremblay. "Analysis of non-pharmacological interventions attempted prior to pro re nata medication use." International Journal of Mental Health Nursing 27, no. 1 (March 1, 2017): 296–302. http://dx.doi.org/10.1111/inm.12320.

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14

Dhandapani, Asha, Sathyan Soundararajan, and Claire Jones. "Audit on use of PRN (pro re nata) psychotropic medication for behavioural disturbance in individuals with intellectual disability in the community." BJPsych Open 7, S1 (June 2021): S75—S76. http://dx.doi.org/10.1192/bjo.2021.240.

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AimsPsychotropic medication is commonly used in people with Intellectual disabilities (ID). This may be attributed in part to an increased prevalence of mental illness in this population and the presence of challenging behaviour which has been shown to increase rates of prescribing. Whilst there are a number of studies looking at regularly prescribed medication there are few studies on “as and when” required (PRN) medication.Psychotropic medication continues to be used to manage behavioural disturbances in people with ID. Where there is no clear cut psychiatric illness, the role of psychotropic medication is an adjunct to a comprehensive multimodal treatment plan.The aim is to find out if prn psychotropic medication for behavioural disturbance is being used appropriately and safely in these individuals.MethodFiles and PRN protocols of individuals known to be using prn psychotropic medications for the management of acute episodes of agitation and behavioural problems and supported by professional staff teams was studied.We collected the data by contacting the residential homes, carers, Collecting details from case notes, from the Staff nurse who made the protocol for their patientsA questionnaire based on the standards mentioned above was developed and files and prn protocols were marked against these standards.ResultThe standards from the medical file were 100 % achieved. Thus indicating the importance of the psychotropic prn medication and documentation of the same.However, the protocol that needs to be with the patient/carers had some lacuna/deficits. Overall only in 53% of the case, standards were achieved. This needs to be highlighted to the team.The Audit gave an insight into what needs to be improved.THE FOLLOWING AREAS NEEDED IMPROVEMENT 1.There should be a prn protocol/ similar instruction to the staff about the use of prn medication(written by appropriately trained professional)2.Prn protocol should be accessible to direct care staff3.There should be a description of when to use the prn medication4.There should be a description of what non-pharmacological de-escalation methods ought to be tried before using prn/ is there a detailed behaviour support plan available5.Protocol should describe what the medication is expected to do6.Protocol should describe the minimum time between doses if the first dose has not worked7.Protocol should state the maximum dose in 24 hour period8.Use of prn should be recordedConclusionI hope this audit will help in improving the patient care with the right psychotropic prn medication, with correct doses and further details as mentioned in the standards of the protocol.We also hope to ensure that in our area, prn psychotropic medication used for agitation and behavioural disturbance is used safely, appropriately and consistently by staff teams. This would be in accordance with the guidelines.

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15

Stein-Parbury, Jane, Kim Reid, Narelle Smith, Diane Mouhanna, and Fiona Lamont. "Use of Pro Re Nata Medications in Acute Inpatient Care." Australian & New Zealand Journal of Psychiatry 42, no. 4 (January 2008): 283–92. http://dx.doi.org/10.1080/00048670701881553.

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16

Jimu, Moreblessing, and Louise Doyle. "The Administration of Pro re nata Medication by Mental Health Nurses: A Thematic Analysis." Issues in Mental Health Nursing 40, no. 6 (March 27, 2019): 511–17. http://dx.doi.org/10.1080/01612840.2018.1543739.

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Cleary, Michelle, Jan Horsfall, Debra Jackson, Maureen O'Hara-Aarons, and Glenn E. Hunt. "Patients' views and experiences of pro re nata medication in acute mental health settings." International Journal of Mental Health Nursing 21, no. 6 (May 14, 2012): 533–39. http://dx.doi.org/10.1111/j.1447-0349.2012.00814.x.

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18

Gerson, Ruth. "28.5 Consensus Guidelines for Pro Re Nata Medication for Agitation in the Emergency Department." Journal of the American Academy of Child & Adolescent Psychiatry 56, no. 10 (October 2017): S43. http://dx.doi.org/10.1016/j.jaac.2017.07.169.

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19

Hipp, Kirsi, Lauri Kuosmanen, Eila Repo-Tiihonen, Minna Leinonen, Olavi Louheranta, and Mari Kangasniemi. "Patient participation in pro re nata medication in psychiatric inpatient settings: An integrative review." International Journal of Mental Health Nursing 27, no. 2 (December 21, 2017): 536–54. http://dx.doi.org/10.1111/inm.12427.

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20

Koçak, Fatma Özge Kayhan, Emin Taşkıran, Zehra Kosuva Öztürk, and Sevnaz Şahin. "Potentially Inappropriate Medication Use among Nursing Home Residents: Medication Errors Associated with Pro re nata Medications and the Importance of Pill Burden." Annals of Geriatric Medicine and Research 26, no. 3 (September 30, 2022): 233–40. http://dx.doi.org/10.4235/agmr.22.0096.

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Background: The use of potentially inappropriate medications (PIM) has become more common among nursing home residents (NHR). This study focused on drugs initially prescribed as pro re nata (PRN) medications and pill burden in association with PIM among NHR. Methods: This observational cross-sectional study was conducted between March and April 2019 on 225 adult NHR aged ≥60 years. Results: The prevalence of PIM was 47.6% among NHR according to the Screening Tool of Older Persons' Prescriptions (STOPP) criteria version 2. The most frequent PIM was the use of any drug prescribed without evidence-based clinical indication; most medication errors were associated with PRN medications. The prevalence rates of PRN in non-PIM and PIM users were 12% and 62.4%, respectively. PRN medications that most commonly caused PIM were non-steroidal anti-inflammatory drugs and proton pump inhibitors. The cut-off value for both medications and pills to correctly identify participants with PIM was 5.5. Pill burden had a similar sensitivity to polypharmacy in identifying individuals with PIM.Conclusion: Medication errors associated with PRN medications were overlooked as factors that increased the risk of PIMs. The most common error related to PRN medications was the continued daily use despite symptom resolution.

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Mistry, Heena. "The monitoring and use of Pro re nata (PRN) psychotropic medication for people with learning disabilities on an inpatient ward." BJPsych Open 7, S1 (June 2021): S92. http://dx.doi.org/10.1192/bjo.2021.278.

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AimsThis project was designed to evaluate the use of PRN medication and PRN monitoring charts on an adult learning disability ward. These charts had been designed by the trust to provide us with a way of monitoring the use of psychotropic PRN medication to ensure monitoring of treatment response, physical health and side effects.MethodThe data were collected from PRN monitoring charts, electronic case notes and electronic prescribing chart records for all patients on an adult learning disability inpatient unit. The sample consisted of 7 patients who had been prescribed and/or received PRN psychotropic medication over a five week period. Quantitative data were derived by simple calculation for the total amount of PRN medication used and number of PRN monitoring charts completed. Qualitative data were collected of prescription charts and PRN protocols which is supposed to guide treatment.ResultOut of all the incidences where PRN medication was administered, only 64% of monitoring charts were completed. Out of the 7 patients on the ward, 6 had PRN protocol charts and for only 5 patients these were followed.ConclusionClinical practice must be improved. The results were presented to ward staff and doctors to discuss the implications for patient care and ways to improve clinical practice by ensuring full monitoring of the use of PRN medication to help reduce the overmedication of people with learning disability by improving the use of the PRN charts. NICE guidelines and The Royal College of Psychiatrists have published guidelines on the prescription of psychotropic drugs for people with learning disabilities. NHS England have also published an article to discourage over-medication of people with learning disabilities. There is a risk that doctors are prescribing medication to treat behaviour that is an expression of distress or a mode of communication rather than a mental disorder. Doctors have a responsibility to ensure they have fully assessed the person's potential to benefit from medication before they prescribe. The audit would serve to provide a baseline for this team prior to any audits in the future.

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Stasinopoulos, Jacquelina, J. Simon Bell, Taliesin E. Ryan-Atwood, Edwin C. K. Tan, Jenni Ilomäki, Tina Cooper, Leonie Robson, and Janet K. Sluggett. "Frequency of and factors related to pro re nata (PRN) medication use in aged care services." Research in Social and Administrative Pharmacy 14, no. 10 (October 2018): 964–67. http://dx.doi.org/10.1016/j.sapharm.2017.11.004.

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Pan, Katherine, Tahsin N. Hasan, Jaclyn D. Chua, Jisoo Kim, Chetan Chauhan, David M. Margulies, Peng Pang, and Gabrielle A. Carlson. "1.60 Impact of Milieu on Pro re nata (PRN) Medication Use in a Children's Inpatient Unit." Journal of the American Academy of Child & Adolescent Psychiatry 56, no. 10 (October 2017): S173. http://dx.doi.org/10.1016/j.jaac.2017.09.074.

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Caisley, H., and U. Müller. "Adherence to medication in adults with attention deficit hyperactivity disorder and pro re nata dosing of psychostimulants: A systematic review." European Psychiatry 27, no. 5 (July 2012): 343–49. http://dx.doi.org/10.1016/j.eurpsy.2012.01.002.

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AbstractAdherence to a regular medication regimen may be challenging for adults with attention deficit hyperactivity disorder (ADHD). Some report taking psychostimulants on a pro re nata (PRN) basis. This review aims to establish the rate of adherence, and reasons for and consequences of non-adherence to medication for ADHD in adults, and to review literature on PRN dosing of psychostimulants in these patients. A systematic literature search was conducted. Four primary research studies have investigated the rate of adherence to medication in adults with ADHD. Mean adherence rate in two studies ranged from 52% to 87%. A number of possible reasons for poor adherence have been suggested. Prospective studies are needed to further define the rate of adherence and causes of poor adherence. Evidence examining whether differences in adherence affect clinical outcomes is equivocal. Therefore, caution should be applied to the assumption that maximising adherence to regular medication regimens will improve clinical outcomes. Two articles acknowledge that patients take medication on a PRN basis. Studies comparing the effectiveness of a regular and PRN regimen of psychostimulants are needed. If PRN dosing is as effective as a regular regimen, advantages might include enhanced doctor-patient communication, reduced side effects and cost savings.

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Baker, Megan, and Gabriellle A. Carlson. "What do we really know about PRN use in agitated children with mental health conditions: a clinical review." Evidence Based Mental Health 21, no. 4 (October 25, 2018): 166–70. http://dx.doi.org/10.1136/ebmental-2018-300039.

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What is the evidence that ‘pro re nata’ (PRN) medication is effective for ending agitated outbursts in children and adolescents in psychiatric emergency rooms or inpatient units? Literature search was performed for studies of PRN medication use in children and adolescents that included an outcome measure. One randomised controlled trial, three prospective studies and six retrospective studies that included some outcome measure were identified. Outcome measures were heterogeneous, and frequently did not use standardised metrics assessing agitation level to measure effectiveness. The single small Randomized Controlled Trial (RTC) does not find a difference between placebo and medication, and outcomes of other studies do not control for potential placebo effect of the intervention itself as opposed to the medication. There is insufficient evidence to support the common practice of PRN medications for the management of acute agitation, and no data with which to inform clinical practice, such as which medicines and doses are helpful for specific populations or situations. Psychiatrists have no evidence-based medication interventions for acutely managing agitated outbursts in children and adolescents.

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Dörks, Michael, Guido Schmiemann, and Falk Hoffmann. "Pro re nata (as needed) medication in nursing homes: the longer you stay, the more you get?" European Journal of Clinical Pharmacology 72, no. 8 (April 14, 2016): 995–1001. http://dx.doi.org/10.1007/s00228-016-2059-4.

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Vaismoradi, Mojtaba, Cathrine Fredriksen Moe, Flores Vizcaya-Moreno, and Piret Paal. "Ethical Tenets of PRN Medicines Management in Healthcare Settings: A Clinical Perspective." Pharmacy 9, no. 4 (October 22, 2021): 174. http://dx.doi.org/10.3390/pharmacy9040174.

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Prescription and administration of pro re nata (PRN) medications has remained a poorly discussed area of the international literature regarding ethical tenets influencing this type of medication practice. In this commentary, ethical tenets of PRN medicines management from the clinical perspective based on available international literature and published research have been discussed. Three categories were developed by the authors for summarising review findings as follows: ‘benefiting the patient’, ‘making well-informed decision’, and ‘follow up assessment’ as pre-intervention, through-intervention, and post-intervention aspects, respectively. PRN medicines management is mainly intertwined with the ethical tenets of beneficence, nonmaleficence, dignity, autonomy, justice, informed consent, and error disclosure. It is a dynamic process and needs close collaboration between healthcare professionals especially nurses and patients to prevent unethical practice.

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Carder, P. C. ""Learning About Your Residents": How Assisted Living Residence Medication Aides Decide to Administer Pro Re Nata Medications to Persons With Dementia." Gerontologist 52, no. 1 (September 7, 2011): 46–55. http://dx.doi.org/10.1093/geront/gnr099.

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Hogan, Kerry-Anne, Julie Lapenskie, Joanne Leclair, Naomi Thick, Mohamed Gazarin, Penny Webster, and Brian Devin. "Implementing Safe Practices in Administering Pro re nata Medications in a Rural Hospital." Journal of Patient Safety 15, no. 4 (December 2019): 302–4. http://dx.doi.org/10.1097/pts.0000000000000276.

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Vaismoradi, Mojtaba, Sue Jordan, Flores Vizcaya-Moreno, Ingrid Friedl, and Manela Glarcher. "PRN Medicines Optimization and Nurse Education." Pharmacy 8, no. 4 (October 26, 2020): 201. http://dx.doi.org/10.3390/pharmacy8040201.

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Medicines management is a high-risk and error prone process in healthcare settings, where nurses play an important role to preserve patient safety. In order to create a safe healthcare environment, nurses should recognize challenges that they face in this process, understand factors leading to medication errors, identify errors and systematically address them to prevent their future occurrence. “Pro re nata” (PRN, as needed) medicine administration is a relatively neglected area of medicines management in nursing practice, yet has a high potential for medication errors. Currently, the international literature indicates a lack of knowledge of both the competencies required for PRN medicines management and the optimum educational strategies to prepare students for PRN medicines management. To address this deficiency in the literature, the authors have presented a discussion on nurses’ roles in medication safety and the significance and purpose of PRN medications, and suggest a model for preparing nursing students in safe PRN medicines management. The discussion takes into account patient participation and nurse competencies required to safeguard PRN medication practice, providing a background for further research on how to improve the safety of PRN medicines management in clinical practice.

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Stubbings, Daniel Robert, Kyle Hughes, and Caroline Limbert. "Staff perceptions of PRN medication in a residential care setting." Journal of Mental Health Training, Education and Practice 14, no. 6 (October 24, 2019): 469–79. http://dx.doi.org/10.1108/jmhtep-10-2018-0059.

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Purpose The purpose of this paper is to explore the perceptions of staff towards psychotropic Pro Re Nata (PRN) medication in a residential care setting. Design/methodology/approach Three male and seven female participants were interviewed using a semi-structured interview. Transcripts were analysed using thematic analysis. Findings Four themes pertaining to PRN medication emerged from the data: behaviour change, calming effect, importance of timing and perceived uniqueness. Research limitations/implications The participant group was not homogenous and findings may have been different in a more qualified cohort. This care setting may not be representative of other environments where PRN medication is administered. The findings do, however, highlight some of the challenges facing the administration of PRN medication in mental health and care settings. Practical implications The awareness of these themes is significant for improving staff knowledge, training practices and policies towards the use and administration of psychotropic PRN medication. Originality/value This is the first study to engage in a thematic analysis of staff views towards the administration of PRN medication.

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Baker, John Anthony, Karina Lovell, and Neil Harris. "Mental health professionals' psychotropic pro re nata (p.r.n.) medication practices in acute inpatient mental health care: a qualitative study." General Hospital Psychiatry 29, no. 2 (March 2007): 163–68. http://dx.doi.org/10.1016/j.genhosppsych.2006.12.005.

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Baker, John A., Karina Lovell, and Neil Harris. "A best-evidence synthesis review of the administration of psychotropic pro re nata (PRN) medication in in-patient mental health settings." Journal of Clinical Nursing 17, no. 9 (May 2008): 1122–31. http://dx.doi.org/10.1111/j.1365-2702.2007.02236.x.

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Martin, Krystle, Elke Ham, and N. Zoe Hilton. "Documentation of psychotropic pro re nata medication administration: An evaluation of electronic health records compared with paper charts and verbal reports." Journal of Clinical Nursing 27, no. 15-16 (July 23, 2018): 3171–78. http://dx.doi.org/10.1111/jocn.14511.

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Morkunas, Bernadette, Kylie Porritt, and Matthew Stephenson. "Experiences of mental health professionals and patients in the use of pro re nata medication in acute adult mental healthcare settings." JBI Database of Systematic Reviews and Implementation Reports 14, no. 10 (October 2016): 209–50. http://dx.doi.org/10.11124/jbisrir-2016-003167.

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Vaismoradi, Mojtaba, Flores Vizcaya Moreno, Hege Sletvold, and Sue Jordan. "PRN Medicines Management for Psychotropic Medicines in Long-Term Care Settings: A Systematic Review." Pharmacy 7, no. 4 (November 25, 2019): 157. http://dx.doi.org/10.3390/pharmacy7040157.

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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.

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Zimmerman, Sheryl, and Philip Sloane. "Psychoactive Prescribing in Assisted Living." Innovation in Aging 4, Supplement_1 (December 1, 2020): 705–6. http://dx.doi.org/10.1093/geroni/igaa057.2480.

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Abstract More than 800,000 older adults reside in almost 30,000 assisted living (AL) communities across the country, 42% of who have moderate or severe dementia. As many as 97% of persons with dementia display symptoms of distress such as agitation or anxiety, and 69% of AL communities provide medications to treat this distress. Unfortunately, the psychoactive medications that are prescribed are often ineffective, contraindicated, and may cause serious adverse events including mortality. Especially concerning is the use of antipsychotic medications, which carry a black-box warning for persons with dementia. This symposium will present data from a seven state study of 250 AL communities and the 13,600 individuals who reside there. The first speaker will discuss the prevalence of psychoactive prescribing in AL overall and by medication type, and community characteristics that relate to use (e.g., staffing, resident case-mix). The second presentation will focus on the use of pro re nata (PRN) psychotropic medications, to examine the extent to which use is situational. The third speaker will address the use of off-label antipsychotic medications, and typologies of AL communities that differentiate use. The fourth speaker will discuss the prevalence of potential antipsychotic side-effects and adverse events, and also family member knowledge of medication use. The final speaker will compare the use of antipsychotic and antianxiety prescribing in proximate AL communities and nursing homes, to examine the extent to which local prescribing patterns may influence use. All five presentations of this symposium convey important issues for practice, policy, and future research.

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Okudo, Jerome, Kenneth Asogwa, and Joel Idowu. "The use and effectiveness of pro re nata psychotropic medications in children and adolescents: A systematic review." Indian Journal of Psychiatry 59, no. 3 (2017): 264. http://dx.doi.org/10.4103/psychiatry.indianjpsychiatry_34_17.

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Hammer, Antje, Anke Wagner, Monika A. Rieger, and Tanja Manser. "Assessing the quality of medication documentation: development and feasibility of the MediDocQ instrument for retrospective chart review in the hospital setting." BMJ Open 9, no. 11 (November 2019): e034609. http://dx.doi.org/10.1136/bmjopen-2019-034609.

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ObjectiveThe medication process requires clear and transparent documentation in patient records. Incomplete or incorrect medication documentation may contribute to inappropriate clinical decision-making and adverse events. To comprehensively assess the quality of in-hospital medication documentation, we developed a retrospective chart review (RCR) instrument. We report on the development process, the feasibility of the instrument and describe our application of the instrument to a sample of patient records.DesignCross-sectional study using an RCR instrument to evaluate paper-based, non-standardised prescription and medication administration charts (MediDocQ).SettingTwo German university hospitals.ParticipantsRecords from 1361 patients admitted between April and July 2015 were evaluated.MethodsThe MediDocQ development process comprised six consecutive stages: focused literature review, web-based search, initial patient record screening, review by project advisory board, focus groups with professionals and pilot testing. The final 54-item RCR instrument covers three key components of medication documentation: (1) completeness of documented information (including prescription, medication administration and pro re nata (PRN) medication), (2) quality of transcriptions and (3) compliance with chart structure, legibility, handling of deletions and chart corrections. Descriptive statistics are presented as mean values, SD, median and interquartile ranges for individual items.ResultsOverall, 33 out of 54 items resulted in mean values above 0.75, indicating high-quality medication documentation. Documentation quality was particularly compromised for verbal and PRN orders (which involve more steps than standard orders) and when documentation was not completed at the same time as medication administration.ConclusionsMediDocQ is a patient safety instrument that can be used to evaluate the quality of medication documentation and identify components of the process where intervention is required. In our setting, standardisation of medication documentation, particularly regarding medication administration and PRN medication is a priority.

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Dean, Angela J., Brett M. McDermott, and James Scott. "Changing Utilization of Pro Re Nata (‘As Needed’) Sedation in a Child and Adolescent Psychiatric Inpatient Unit." Australian & New Zealand Journal of Psychiatry 43, no. 4 (January 1, 2009): 360–65. http://dx.doi.org/10.1080/00048670902721095.

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Objective: The primary purpose of the present study was to examine changes in utilization of pro re nata (PRN; ‘as required’) sedation over time within a child and adolescent psychiatric inpatient unit. The secondary purpose was to assess whether changes in PRN sedation were related to changing patient characteristics. Methods: A retrospective chart review examined 257 medical charts from a child and youth mental health inpatient service over two time periods (wave I, n = 122; wave II, n = 135) and collected data on PRN sedation, patient characteristics and routine medications. Results: Over time a significant reduction was observed in the proportion of patients prescribed PRN sedation from 70% to 54% (p < 0.01), and a reduction in the proportion of patients given PRN sedation from 46% to 26% (p < 0.01). The most commonly administered drug was chlorpromazine in wave I, and diazepam in wave II. Multivariate analysis indicated that reductions in PRN sedation occurred independently of changes in patient characteristics. Conclusions: High utilization rates of PRN sedation are not inevitable in a child and adolescent psychiatric inpatient unit and may be reduced over time. Changing utilization of PRN sedation occurred independently from changing patient characteristics. More treatment outcome studies are required to optimize use of PRN sedation in young people.

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Toby, J. Measham. "The Acute Management of Aggressive Behaviour in Hospitalized Children and Adolescents." Canadian Journal of Psychiatry 40, no. 6 (August 1995): 330–36. http://dx.doi.org/10.1177/070674379504000609.

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Objective To examine how health care professionals attempt to manage acutely aggressive behaviours exhibited by children and adolescents in various hospital settings. Method A review of the literature examining management techniques on child psychiatric and pediatric wards is presented. Techniques reviewed include pharmacotherapy, psychotherapy, seclusion, restraint and the use of pro re nata (prn) medications. Results Effects of various management techniques are presented, where available. Conclusion There is little evidence for the effectiveness of most presently used acute management techniques in containing aggressive child behaviours over the long term. Suggestions for improved evaluation of management techniques are made.

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Nakashima, Taeko, Yuchi Young, and Wan-Hsiang Hsu. "Do Nursing Home Residents With Dementia Receive Pain Interventions?" American Journal of Alzheimer's Disease & Other Dementiasr 34, no. 3 (April 10, 2019): 193–98. http://dx.doi.org/10.1177/1533317519840506.

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This study compares pain interventions received by nursing home residents with and without dementia. Secondary data analyses of cross-sectional data from 50,673 nursing home residents in New York State were collected by the Minimum Data Set 3.0. Frequency distributions and bivariate analyses with χ2 tests were used to organize and summarize the data. Logistic regression analyses were performed to quantify the relationship between dementia and pain interventions. Our results show that residents with dementia had significantly fewer pain assessments and less reported pain presence than their counterparts. After adjusting for covariates, the results indicate that residents with dementia were significantly less likely to receive pro re nata and nonmedication pain intervention. However, there were no significant differences in scheduled pain medication between the 2 groups. To address the gap, we need more research to design a pain assessment tool that can differentiate severity of pain so that appropriate interventions can be applied.

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Procaccini, David, Rebecca Rapaport, Brent Petty, Dana Moore, Dorothy Lee, and Sapna R. Kudchadkar. "Design and Implementation of an Analgesia, Sedation, and Paralysis Order Set to Enhance Compliance of pro re nata Medication Orders with Joint Commission Medication Management Standards in a Pediatric ICU." Joint Commission Journal on Quality and Patient Safety 46, no. 12 (December 2020): 706–14. http://dx.doi.org/10.1016/j.jcjq.2020.06.003.

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BAKER, J. A., K. LOVELL, N. HARRIS, and M. CAMPBELL. "Multidisciplinary consensus of best practice for pro re nata (PRN) psychotropic medications within acute mental health settings: a Delphi study." Journal of Psychiatric and Mental Health Nursing 14, no. 5 (August 2007): 478–84. http://dx.doi.org/10.1111/j.1365-2850.2007.01112.x.

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Wong, Adrian, Mary G. Amato, Diane L. Seger, Christine Rehr, Adam Wright, Sarah P. Slight, Patrick E. Beeler, E. John Orav, and David W. Bates. "Prospective evaluation of medication-related clinical decision support over-rides in the intensive care unit." BMJ Quality & Safety 27, no. 9 (February 9, 2018): 718–24. http://dx.doi.org/10.1136/bmjqs-2017-007531.

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BackgroundClinical decision support (CDS) displayed in electronic health records has been found to reduce the incidence of medication errors and adverse drug events (ADE). Recent data suggested that medication-related CDS alerts were frequently over-ridden, often inappropriately. Patients in the intensive care unit (ICU) are at an increased risk of ADEs; however, limited data exist on the benefits of CDS in the ICU. This study aims to evaluate potential harm associated with medication-related CDS over-rides in the ICU.MethodsThis was a prospective observational study of adults admitted to any of six ICUs between July 2016 and April 2017 at our institution. Patients with provider-overridden CDS for dose (orders for scheduled frequency and not pro re nata), drug allergy, drug–drug interaction, geriatric and renal alerts (contraindicated medications for renal function or renal dosing) were included. The primary outcome was the appropriateness of over-rides, which were evaluated by two independent reviewers. Secondary outcomes included incidence of ADEs following alert over-ride and risk of ADEs based on over-ride appropriateness.ResultsA total of 2448 over-ridden alerts from 712 unique patient encounters met inclusion criteria. The overall appropriateness rate for over-rides was 81.6% and varied by alert type. More ADEs (potential and definite) were identified following inappropriate over-rides compared with appropriate over-rides (16.5 vs 2.74 per 100 over-ridden alerts, Fisher’s exact test P<0.001). An adjusted logistic regression model showed that inappropriate over-rides were associated with an increased risk of ADEs (OR 6.14, 95% CI 4.63 to 7.71, P<0.001).ConclusionsApproximately four of five identified CDS over-rides were appropriately over-ridden, with the rate varying by alert type. However, inappropriate over-rides were six times as likely to be associated with potential and definite ADEs, compared with appropriate over-rides. Further efforts should be targeted at improving the positive predictive value of CDS such as by suppressing alerts that are appropriately over-ridden.

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Martinho, Eduardo, Garrett M. Fitzmaurice, Frances R. Frankenburg, and Mary C. Zanarini. "Pro Re Nata (As Needed) Psychotropic Medication Use in Patients With Borderline Personality Disorder and Subjects With Other Personality Disorders Over 14 Years of Prospective Follow-Up." Journal of Clinical Psychopharmacology 34, no. 4 (August 2014): 499–503. http://dx.doi.org/10.1097/jcp.0000000000000132.

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Ichihashi, Kayo, Yoshitaka Kyou, Naomi Hasegawa, Norio Yasui-Furukori, Yoshihito Shimizu, Hikaru Hori, Naoki Hashimoto, et al. "The characteristics of patients receiving psychotropic pro re nata medication at discharge for the treatment of schizophrenia and major depressive disorder: A nationwide survey from the EGUIDE project." Asian Journal of Psychiatry 69 (March 2022): 103007. http://dx.doi.org/10.1016/j.ajp.2022.103007.

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Seymour, Joanne, Tristan Chapman, Vladan Starcevic, Kirupamani Viswasam, and Vlasios Brakoulias. "Changing characteristics of a Psychiatric Emergency Care Centre. An eight year follow-up study." Australasian Psychiatry 28, no. 3 (May 8, 2018): 307–10. http://dx.doi.org/10.1177/1039856218772252.

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Objective: The objective of this study was to report changes in characteristics of admissions to an established Psychiatric Emergency Care Centre (PECC) eight years after its opening. Method: Key clinical characteristics of admissions to the PECC were documented for 327 patients in 2015 and compared with the 477 patients in 2007, which is when the centre first opened. The characteristics of admission were evaluated using an audit of medical records from June to December in both 2007 and 2015. Results: Statistically significant differences ( p<0.05) between 2007 and 2015 were: a reduction in the numbers of patients admitted with depression; a reduction in the numbers of patients diagnosed with adjustment disorder; an increase in the numbers of patients diagnosed with borderline personality disorder; a reduction in pro re nata (prn) use, including a reduction in the need for chemical restraint with midazolam and a decrease in the length of admission in the PECC. Conclusions: The significant reduction in aggression, the use of prn medication and the number of people with longer stays within the PECC support the usefulness of PECCs in relation to patient satisfaction and adherence to admission criteria policy. These factors may be considered as indicators of the efficiency of a PECC.

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Morkunas, Bernadette, Kylie Porritt, and Matthew Stephenson. "The experiences of mental health professionals' and patients' use of pro re nata (PRN) medication in acute adult mental health care settings: a systematic review protocol of qualitative evidence." JBI Database of Systematic Reviews and Implementation Reports 12, no. 7 (July 2014): 164–72. http://dx.doi.org/10.11124/jbisrir-2014-1669.

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Morkunas, Bernadette, Kylie Porritt, and Matthew Stephenson. "The experiences of mental health professionals and patients in the use of pro re nata medication in acute adult mental health care settings: a systematic review protocol of qualitative evidence." JBI Database of Systematic Reviews and Implementation Reports 14, no. 1 (January 2016): 99–107. http://dx.doi.org/10.11124/jbisrir-2016-2580.

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