The administration of ‘as required’ sedative medication at a secure psychiatric hospital

Abstract

Relatively little research has been conducted into the use of pro re nata (PRN) medication in psychiatry. This article describes the frequency, nature and reasons for the administration of sedative PRN medication among inpatients at a secure psychiatric hospital and audits its documentation against good practice standards. Medication charts and case notes were scrutinised for doses of PRN medication administered in the previous 14 days. A total of 344 patients were studied. Thirty-four percent had received PRN medication in the previous fortnight. Most of the 618 doses (93%) were administered orally and none were described as rapid tranquillisation. There was no evidence of physical monitoring following PRN administration. Case note documentation was patchy, with no mention was made of side effects and in just 40% was the reason for using PRN recorded. In only 31% of instances was the outcome documented. PRN medication was commonly administered but poorly documented. Nursing staff need reminding that good case note documentation is important both clinically and for medicolegal reasons when administering sedative medication to patients.