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SL58-PRN Medication Management Policy

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Registration Number: {{org_field_registration_no}}

PRN (Pro Re Nata) Medication Management Policy

1. Purpose

{{org_field_name}} is committed to the safe, effective and person-centred management of PRN (pro re nata, or “when required”) medicines for people receiving Personal Care and medicines support within our Supported Living service.

This policy sets out how {{org_field_name}} will assess, plan, administer, record, monitor and review PRN medicines so that they are used only when clinically appropriate and in accordance with the prescriber’s directions and the person’s individual care plan.

This policy supports compliance with:

The objectives of this policy are to ensure that:

{{org_field_name}} is registered with the Care Quality Commission to carry out the regulated activity of {{org_field_regulated_activity}} for {{org_field_service_users_bands}} in supported living settings.

2. Scope

This policy applies to all staff involved in the management of PRN medication, including support workers, registered nurses, team leaders, and managers. It covers all aspects of PRN medication use, including storage, administration, record-keeping, and safeguarding against misuse or overuse.

3. Related Policies

4. Definition of PRN Medication

PRN (Pro Re Nata) medication is prescribed to be taken only when required, rather than at scheduled times. It is used to manage short-term symptoms, such as:

PRN medication must be administered only when clinically necessary, in accordance with the individual’s PRN protocol.

5. Assessment and Prescription of PRN Medication

PRN medicines must only be administered where there is a valid prescription or other lawful authorisation from an appropriately authorised prescriber and clear instructions for their use.

PRN medicines must form part of the person’s assessed medicines-support needs and be recorded in their individual care and support plan.

Before {{org_field_name}} takes responsibility for supporting or administering a PRN medicine, the organisation must ensure that sufficient information is available to enable staff to administer it safely and as intended by the prescriber.

A person-specific PRN protocol must be available for each PRN medicine administered by staff.

The protocol must be consistent with:

The PRN protocol must include, where applicable:

Where a variable dose is prescribed, the protocol must give clear criteria for deciding which prescribed dose should be administered. Staff must not make an independent clinical decision to alter a dose where there are no clear authorised instructions.

Where information is unclear, inconsistent or incomplete, staff must not guess. Advice must be obtained from the prescriber, pharmacist or another appropriate healthcare professional before the medicine is administered, unless urgent emergency action is required.

The person’s medicines support and PRN arrangements will be developed with the person and, where appropriate and lawful, relevant representatives and healthcare professionals.

6. Consent and Mental Capacity

PRN medicines will be managed in accordance with Regulation 11 – Need for consent and the Mental Capacity Act 2005.

A person will be presumed to have capacity to make decisions about their medicines unless there is reason to doubt their capacity in relation to the specific decision.

Where the person has capacity:

Consent is an ongoing process and must not be assumed solely because the medicine has previously been accepted.

Where there is reason to doubt the person’s capacity to make a particular decision concerning their PRN medicine, capacity will be assessed in accordance with the Mental Capacity Act 2005.

Capacity assessments must be:

A person must not be treated as lacking capacity merely because they make a decision that others regard as unwise.

Where a person lacks capacity to make the relevant medicines decision, any decision made on their behalf must:

PRN medication must not be administered covertly merely because a person refuses it.

Any proposed covert administration must follow {{org_field_name}}’s Covert Medication procedure and the requirements of the Mental Capacity Act 2005, including a properly documented best-interest decision and appropriate prescriber and pharmacist involvement.

Where the person has fluctuating capacity, staff will consider the person’s capacity at the relevant time and, where clinically safe and practicable, support them to make the decision when they are able to do so.

7. Storage and Security

PRN medicines belong to the person for whom they have been prescribed and will be stored within their home in accordance with their individual medicines-support arrangements.

Storage arrangements will be determined through an individual assessment and will take account of:

PRN medicines must:

Where {{org_field_name}} is responsible for medicines storage, the storage arrangements and the organisation’s responsibilities must be clearly recorded in the person’s care plan.

Where temperature-controlled storage is required and {{org_field_name}} has responsibility for that storage, appropriate monitoring arrangements will be implemented.

Expired, discontinued or unwanted PRN medicines will be managed in accordance with the organisation’s Medicines Management and Disposal procedures and the agreed arrangements for medicines in the person’s own home.

8. Administration of PRN Medication

PRN medicines may only be administered by staff who have been appropriately trained, assessed as competent and authorised by {{org_field_name}} to undertake medicines administration.

Staff must only administer PRN medicines that are:

Before administering a PRN medicine, staff must:

Staff will observe the six rights of medicines administration:

The medicine must be administered strictly in accordance with the prescription, dispensing label and person-specific PRN protocol.

Where a variable dose is prescribed, staff must follow the documented criteria for selecting the dose. Staff must not independently invent a dose sequence or dosage strategy.

Where more than one PRN medicine is prescribed for the same indication, staff must follow the documented instructions specifying which medicine should be used first and when another medicine may be considered.

Staff must not administer a PRN medicine where:

In these circumstances, advice must be obtained from the prescriber, pharmacist, NHS 111 or another appropriate healthcare professional according to the urgency and circumstances.

After administration, staff must monitor the person in accordance with the PRN protocol and record whether the medicine produced the intended effect.

9. Record-Keeping and Documentation

Every occasion on which {{org_field_name}} provides PRN medicines support must be recorded accurately and promptly.

Where staff administer a PRN medicine, the administration must be recorded on the person’s current Medication Administration Record (MAR) or approved electronic medicines administration record.

The record must include, as applicable:

The outcome and effectiveness must be recorded at the time specified in the person’s PRN protocol or within an appropriate period based on the expected onset of action of the medicine.

Where the medicine is ineffective, staff must follow the escalation instructions within the person’s PRN protocol and seek appropriate healthcare advice where required.

Where a person with capacity declines a PRN medicine:

Where another person, such as a family member or carer, administers PRN medication outside staff support times, the person’s care plan must clearly state how this will be communicated and recorded so that staff can determine safely whether further doses may be given.

MAR charts and PRN records must remain accurate and up to date.

Any discrepancy, omission, duplicate administration, recording error or uncertainty must be escalated promptly in accordance with the organisation’s Medicines Management and Incident Reporting procedures.

10. Monitoring and Review

PRN medicines will be monitored to ensure that their use remains safe, clinically appropriate, effective and consistent with the person’s preferences and current needs.

Staff and managers will monitor, where applicable:

The person’s PRN arrangements will be reviewed at the interval specified in their care plan, prescription, PRN protocol or by the relevant healthcare professional.

An earlier review will be sought where:

Where a clinical medication review is required, {{org_field_name}} will request or facilitate review by an appropriate prescriber, pharmacist or other suitably qualified healthcare professional.

Care staff and social care managers must not independently alter, discontinue, reduce or increase a prescribed PRN medicine.

The outcome of any medication review that affects care delivery must be:

11. Preventing Misuse, Over-Medication and Improper Restraint

PRN medicines must only be administered for the clinical indication for which they have been prescribed and in accordance with the authorised directions and person’s care plan.

Where a PRN medicine is prescribed to support a person who may experience distress, agitation or behaviour that challenges, the person’s care plan must include sufficient person-centred information to guide staff.

This should include, where relevant:

Non-medicine approaches must be considered where appropriate but must not be used to delay clinically necessary treatment.

Staff must report promptly any concern involving:

The concern must initially be managed through the organisation’s medicines incident and escalation procedures.

The Registered Manager or Safeguarding Lead will assess whether the circumstances constitute or indicate a safeguarding concern under Regulation 13 and will make a referral to the Local Authority Safeguarding Adults Team where required.

Where a crime is suspected, the police will also be contacted where appropriate.

CQC notification requirements will be considered separately in accordance with the applicable statutory notification regulations.

12. Staff Training and Competency

Only staff who have received appropriate medicines training and have been assessed as competent may administer PRN medicines on behalf of {{org_field_name}}.

Before administering PRN medicines independently, staff must demonstrate competence in:

Competency must be formally assessed and documented before the member of staff administers medicines independently.

The person undertaking the competency assessment must themselves be competent to assess the medicines-support tasks undertaken by the service.

Staff knowledge, skills and competency relating to medicines management and administration will be reviewed at least annually.

Additional competency review or retraining will take place where appropriate following:

Records of:

will be maintained securely.

Staff must not undertake medicines tasks for which they have not been trained and assessed as competent.

13. Confidentiality, Data Protection and Information Sharing

PRN medicines records contain confidential health information and must be managed in accordance with:

Records must be:

Information about a person’s medicines may be shared with appropriate health and social care professionals where there is a lawful basis and where sharing is necessary and proportionate to provide safe and effective care.

Where information is shared with family members, friends or other representatives, staff must consider:

Information necessary for safe medicines management must be communicated appropriately during transfers of care or changes in medicines support.

14. Legal and Regulatory References

This policy is informed by the following legislation and guidance:

15. Policy Review

This policy will be reviewed at least annually and earlier where necessary following:

The Registered Manager is responsible for ensuring that this policy remains current and consistent with the organisation’s main Medicines Management Policy and other related policies.

Any changes affecting staff practice will be communicated to relevant staff and supported by additional training or competency assessment where required.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.

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