Ethical Tenets of PRN Medicines Management in Healthcare Settings: A Clinical Perspective

Abstract

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.

Nurses' use of pro re nata medication in adult acute mental healthcare settings: An integrative review

“…There were a number of factors contributing to PRN medicine use and reasons to proceed with PRN administration. Unfortunately, it was found that these were not necessarily patient‐oriented and evidence‐based, a worrying issue when short‐term effects and possible prolonged harm needs to be balanced (Vaismoradi et al, 2021). This finding concurs with the last systemic review which indicated that PRN medication's administering and prescribing varied based on the situation, organization, and individuals (Morkunas et al, 2016).…”

“…Psychotropic PRN medications include antipsychotics, benzodiazepines, and sedatives, and these are commonly used in mental health settings in response to agitation, anxiety, and insomniac conditions (Jimu & Doyle, 2019). The advantage of psychotropic PRN medications is to enable nurses to respond to the patients' immediate clinical needs rather than waiting for regular dose administration (Harper et al, 2017), and from the patient's point of view, they can ask for PRN medication to control their symptoms on an as‐needed basis (Vaismoradi et al, 2021). The disadvantages of psychotropic medication involve the potential negative outcomes for patients' health, such as metabolic syndrome, morbidity, polypharmacy, drug dependence, overuse, and adverse drug interactions (Barr et al, 2018).…”

“…On the other hand, PRN medications can be requested or declined by patients themselves, according to their perceived clinical needs (Hipp et al, 2021), so the purpose of PRN medication administration is not to sedate or control a person's behaviour (Casol et al, 2021), but to meet patient's therapeutic needs, providing relief to their agitation, and some reduction in the symptoms causing them to become agitated (Martin et al, 2017). Unlike chemical restraint, the PRN administration process is somewhat collaborative with patients because nurses take the opportunity to explore other coping strategies (Hipp et al, 2021) and provide education to their patient (Vaismoradi et al, 2021).…”

“…Finally, PRN medication administration usually requires consent (Vaismoradi et al, 2021), even though the literature shows that consent is not always documented (Martin et al, 2018a) or obtained (Cleary et al, 2012, as cited in Hipp & Kangasniemi, 2022 p. 2). PRN medications can pose a risk to patient care outcomes if not used with caution.…”

“…Generally speaking, PRN administration is at the discretion of nurses, yet there is lack of decent evidence from randomized clinical trials research to uncover how the clinical decision process was made (Vaismoradi et al, 2021). There may be significant differences in PRN practice, and how the mental health professionals' practices affects the use of PRN medications remains unclear.…”