Use of Pro Re Nata Medications in Acute Inpatient Care

Abstract

PRN medication use has endured as standard practice and the results of the present study are consistent with the reported frequency of use increasing slightly over the years. The combination of second-generation antipsychotics as regular medications and benzodiazepines for PRN medication is consistent with recommended treatment guidelines. The small subset of patients who were overrepresented in the PRN administrations is noteworthy.

Gender-specific differences in nursing staff’s administration patterns of ‘pro re nata’ medication: A prospective observational study

“…PRN medication use has increased as standard practice in acute patient care, but in recent studies a poor documentation of prescription and administration of these drugs was found [11,18]. In our study, we used a patient data management system, which has been established a longer time ago and all the intensive care staff were strictly committed …”

“…Antiemetics, cathartic medicine, analgosedatives and blood pressure medication are often prescribed on a 'pro re nata' (PRN) or 'as needed' basis. In these cases, time points of prescription, doses and frequencies are not scheduled but can be individually adjusted to the patient's needs [9][10][11]. The 'need for medication' may be expressed verbally or nonverbally by the patient, depending on his/her condition, or identified via assessments by the caretaker [12,13].…”

“…Bedside nurses can be in charge for the administration of PRN medication, given that they are present at the bedside more often than the physicians [11,14,15]. This has been shown to lead to a quicker treatment, in case that PRN medication can be given autonomously by the nurses within the limits of the physician's prescription [11,[15][16][17][18]. Consequently, this comes along with a high grade of freedom of action and responsibility for the care staff [10,12,19].…”

“…Furthermore, the prescription pattern of PRN might be influenced by beliefs, attitudes, perceived norms, perceived behavioral control, intentions, and experience. Bedside nurses can be in charge for the administration of PRN medication, given that they are present at the bedside more often than the physicians [11,14,15]. This has been shown to lead to a quicker treatment, in case that PRN medication can be given autonomously by the nurses within the limits of the physician's prescription [11,[15][16][17][18].…”

Nurses' Knowledge of Signs and Symptoms of Anxiety and Agitation

“…This responsibility rests solely on the nursing staff and their ability to use autonomous clinical decision-making to distinguish between different behaviors associated with those conditions prior to the administration of PRN medication (Hilton & Whiteford, 2008;Usher et al, 2009). Approximately 75% of hospital psychiatric patients receive PRN medications and there are presently few studies that explore nurses' rationale for the decision-making processes when administrating those medications (Stein-Parbury, Reid, Smith, Mouhanna, & Lamont, 2008;Usher et al, 2009;Winship, 2010).…”