Pro re nata medication for psychiatric inpatients: time to act

Michael Hilton and Whiteford, Harvey (2008) Pro re nata medication for psychiatric inpatients: time to act. Australian And New Zealand Journal of Psychiatry, 42 7: 555-564. doi:10.1080/00048670802119804

Author Michael Hilton
Whiteford, Harvey
Title Pro re nata medication for psychiatric inpatients: time to act
Journal name Australian And New Zealand Journal of Psychiatry   Check publisher's open access policy
ISSN 0004-8674
Publication date 2008-01-01
Year available 2008
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1080/00048670802119804
Open Access Status DOI
Volume 42
Issue 7
Start page 555
End page 564
Total pages 10
Editor Peter Joyce
Place of publication United Kingdom
Publisher Informa Healthcare
Language eng
Subject 321204 Mental Health
920209 Mental Health Services
111714 Mental Health
Abstract Pro re nata (PRN; 'as needed') medication is an archetypal mainstay for managing acute psychiatric inpatient symptoms and behaviours. Psychiatric and mental health nursing practices have circumnavigated the development of a uniform medical-ethical standard for the administration of PRN psychotropic medication. This paper examines the evidence for administration of PRN psychotropic medications and, in the context of evidence-based best practice, current mental health policy and professional ethics, proposes a standardized Australian PRN administration protocol. The procedures and circumstances leading to a nurse administering psychotropic PRN medication are divided into five simple steps, namely (i) medical prescription; (ii) nurse evaluation of patient indications for an intervention; (iii) nurse consideration of therapeutic options; (iv) obtaining patient informed consent; and (v) documentation of outcomes of PRN administration. The literature associated with each step is reviewed, along with national and international professional ethics, guidelines and patient rights documents pertaining to the care of mental health patients. Recommendations for best-practise care are discussed for each step. There is a lacuna of published evidence supporting the use of PRN medications in psychiatric inpatients. Yet there is published evidence that PRN medications are associated with increased risks of morbidity, inappropriate use, may result in above-recommended dosages or polypharmacy, and complicate the assessment of efficacy of regular scheduled medicines. Alternative non-pharmacological treatment options to PRN medication are effective and associated with fewer side-effects. There are no national explicit standards, operational criteria or quality assurance for the use of PRN medication in inpatient psychiatric units. Contemporary PRN practices are largely unregulated and driven by essentially anecdotal evidence, leaving the clinicians and the service open to claims of poor accountability and misuse (intentional and unintentional) of psychotropic medications. Development of best practice guidelines for the use of PRN administration is essential.
Keyword Psychiatry
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: 2009 Higher Education Research Data Collection
School of Public Health Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 18 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 19 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Fri, 27 Mar 2009, 22:11:24 EST by Carmel Meir on behalf of School of Public Health