PRN Medicines Management for Psychotropic Medicines in Long-Term Care Settings: A Systematic Review.

Mojtaba Vaismoradi,Sue Jordan,Flores Vizcaya Moreno,Hege Sletvold

doi:10.3390/pharmacy7040157

Abstract

Many medications are prescribed and administered PRN (pro re nata, as needed). However, there are few integrative reviews to inform PRN psychotropic medication use in long-term care facilities and nursing or care homes. Accordingly, this integrative systematic review aimed to improve our understanding of PRN medicines management with a focus on psychotropic medications (antipsychotics, sedatives, anxiolytics, and hypnotics) in long-term care settings. Keywords relating to PRN in English, Norwegian, and Spanish were used, and articles published between 2009 and 2019 were retrieved. Based on the inclusion criteria, eight articles were used for data analysis and synthesis. This review offers a description of PRN prescription and administration of psychotropic medications in long-term care. Variations were observed in the management of PRN psychotropic medications based on residents’ underlying health conditions and needs, duration of use, and changes between medications and doses. Neither the reasons for PRN prescription and administration nor the steps taken to identify and manage any associated adverse reactions or adverse drug events were reported. Further initiatives are needed to improve PRN medicines management to explore factors that affect PRN prescription and administration and to develop appropriate PRN guidelines to prevent harm and improve the safety of people living in long-term care facilities.

Highlights

PRN stands for “pro re nata,” and indicates authorising nurses to administer medications according to patients’ requests and nurses’ discretion
The selected studies comprised three studies from Australia [37,43,44], one from the USA [38], one from Norway [39], one from Canada [40], and two from Germany [41,42]. They were all published in English except one that was in Norwegian [39]
This systematic review focused on the PRN prescription and administration of psychotropic medications in long-term care settings

Summary

Introduction

PRN stands for “pro re nata,” and indicates authorising nurses to administer medications according to patients’ requests and nurses’ discretion. PRN is categorized as unscheduled medication administration either alone or in addition to routine/regular prescriptions [1]. It is frequently used for medications prescribed by physicians and administered based on nurses’ judgements of patients’. PRN is commonly used to prescribe medications required in particular conditions, such as a complement to regularly scheduled medications [8]. It empowers nurses and patients and gives them more flexibility for relieving unpleasant physical and mental symptoms [2,9]. PRN medication decision-making for nurses is complex, and is influenced by pharmacotherapeutic competencies and skills, patient and family involvement, Pharmacy 2019, 7, 157; doi:10.3390/pharmacy7040157 www.mdpi.com/journal/pharmacy

Methods

Results

Discussion

Conclusion