Aims and objectives To understand how acute care nurses make decisions about administering “as‐needed” (PRN) psychotropic medications to hospitalised people with dementia (PWD). Background Behavioural and psychological symptoms of dementia occur in approximately 75% of PWD admitted to acute care. Despite this, few studies provide insight into the use and prevalence of psychotropic use in acute care. Design A qualitative descriptive design was used to explore acute care nurses’ decision‐making about PRN psychotropic medication administration to PWD. Methods Semi‐structured interviews were conducted with eight nurses from three acute care medical units in a large tertiary hospital in Western Canada. Conventional content analysis was used to develop three themes that reflect nurses’ decision‐making related to administering PRNs to hospitalised PWD. COREQ guidelines were followed. Results Three themes of legitimising control, making the patient fit and future telling were developed. Legitimising control involved medicating undesirable behaviours to promote the nurses’ perceptions of safety. Making the patient fit involved maintaining routine and order. Future telling involved pre‐emptively medicating to prevent undesirable behaviours from escalating. Nurses provided little to no mention of assessing for physical causes contributing to behaviours. PRNs were seen as a reasonable alternative to physical restraints and were frequently used. Additionally, organisational and unit routines greatly influenced nurses’ decision‐making. Conclusions These findings provide an initial understanding of how nurses make decisions to administer PRN medications to hospitalised older people and may inform prescribing practices. There were novel findings about the lack of assessment prior to PRN administration, and the nurses’ collective response in decision‐making. More research is needed to better understand the complexities of nurses’ decision‐making, to assist in the development of interventions for nursing practice.

Behavioural and psychological symptoms of dementia occur in approximately 75% of people with dementia admitted to acute care. Acute care nurses’ decision‐making regarding administering ‘as needed’ (pro re nata or PRN) psychotropic medications to persons with dementia are not well understood. This is an important clinical concern because ‘as needed’ medications are given at the discretion of the nurse. A comprehensive, systematic search and screen for studies that explored nurses’ decision‐making related to administering as needed psychotropic medication to persons with dementia in acute care settings was conducted. No studies that reported nurses’ decision‐making related to administration of as needed psychotropic medications to hospitalized persons with dementia were identified. In light of this, we present a discussion based on a narrative review of what is known on this topic from other settings, based on papers found in our original review. We will briefly explore what is needed in future research to address the gap in knowledge about nurse’ decision‐making related to administering as needed psychotropic medications.Implications for practiceResearch is needed to understand and inform the decision‐making process in the administration of as needed psychotropic medications to hospitalized persons with dementia.

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