As Required Psychotropic
PRN is widely used as an intervention to manage acute behavioural disturbance in mental health in-patient settings. They are intended to be available for staff to administer at their discretion to patients as part of the management of acute psychiatric symptoms such as agitation, anxiety and distress. A Scotland wide ‘PRN’ psychotropic medication audit in January 2011 highlighted patients were as often as they should be, post administration, to review the psychological and physical effects of medication. Local and national audits have identified that these drugs are often prescribed without appropriate care, administered unnecessarily and the details surrounding their use is often inadequately documented. There is also a lack of review leading to almost open ended prescriptions.
Whilst initially the work to improve the use of PRN medication was around increasing monitoring and review of the medication, there has been a move to review the whole process and use of ‘PRN’. The practice of routinely prescribing medication on admission is being challenged, as is the frequency of review. Of the NHS boards across Scotland who have been routinely collecting data there is evidence to suggest certain patterns indicating increased administration of medication at particular times.
Initial testing concluded the use of a sticker (Oral/Intra-Muscular sedation) in a patient’s notes used to highlight that a medication had been given has contributed to increased MDT awareness of as required administration and has improved monitoring of their effectiveness and efficacy of use. This has supported positive challenges to prescribing and administration practices and the promotion of non-pharmacological intervention.