PRN psychotropic drug use on a psychiatric unit

Abstract

PRN psychotropic drug use is a frequent practice on psychiatric units. This study examined medical records for patient demographics and prescribing patterns of drugs. The omission of the indication and frequency of dosing for the drug were common prescribing errors. There was no significant association between diagnosis and whether a patient received PRN drugs. Anxious patients were significantly more likely to receive PRN anxiolytics whereas psychotic patients were as likely to receive PRN anxiolytics as antipsychotics. Anxiolytics also were significantly more likely to be judged effective by the nursing staff than antipsychotics. A perplexing finding was that manic and schizophrenic patients were significantly less likely to receive PRN hypnotics than were patients with Major Depression. The clinical implications of the findings are discussed and recommendations are made to improve standards of practice for this commonplace treatment.

Use of Pro Re Nata Medications in Acute Inpatient Care

“…It is encouraging to note that documentation regarding the 'outcome of administration' was recorded in significantly more of the patient records audited in the present study, than in prior studies [1Á3, 5,7].…”

“…As reported in many previous studies, documentation in patient notes is either missing or incomplete [1Á5, 7,10].…”

“…Other studies reported a lack of documentation regarding the effects of the medication that occurred in up to 64% of the times a nurse administered a PRN medication [1Á3, 5,7].…”

A study of the use of sedative PRN medication in patients at a secure hospital

“…Craven, Voore, and Voineskos (1987) found an association with personality disorder and use of PRN medication, while our finding was of an association between emotionally unstable but not antisocial personality disorder. The other study of PRN administration to comment upon diagnosis in relation to PRN utilisation is that of Walker (1991) which was conducted in an acute psychiatric unit and did not find an association between particular diagnoses and PRN administration. In our study, high users of PRN medication were characterised by female gender, younger age, detention on a civil section and a diagnosis of emotionally unstable personality disorder.…”

“Stat” Medication Administration Predicts Hospital Discharge

“…Forty-five percent of all patients ''Agitation stat''-intramuscularly administered antipsychotic medications (non-depot) or intramuscular lorazepam in the New York State psychiatric hospital system receiving antipsychotic medication also received at least one ''stat'' medication order in 2005, over a period of observation averaging 198 days. Other studies [20][21][22][23] have also demonstrated common use of additional as needed medications, such as a prospective study conducted in an acute university hospital setting in Switzerland [20], where 71% of the patients in a closed ward ultimately received an ''as needed'' drug over a 35-day period, including non-psychotropic medication, with almost 90% of the ''as needed'' medication being oral. In a one-month retrospective study at a state hospital in New York (that remains as one of the 17 hospitals whose data is included in this report), 23% of patients received a medication administered ''stat'' [21].…”