WCH182. Medication to be “Taken as Required” (PRN) in Care Homes
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Medication to be “Taken as Required” (PRN) in Care Homes Policy
This policy provides a framework for the administration of all “Taken as Required” medicines. It should be read in relation to {{org_field_name}}’s other medication policies, including a separate policy on Rescue and Emergency Use Medicines, which are particular examples of medicines to be taken as required.
The policy, as are all other medication policies, is written in line with the National Institute for Clinical and Health Excellence (NICE) Guidance SC1: Managing Medicines in Care Homes (2014) and NICE Quality Standard QS85: Medicines Management in Care Homes (2015).
Background
Most medication is prescribed with clear instructions of how much should be taken and how often.
However, some medication is prescribed on a “taken as required” dose, sometimes abbreviated as PRN (pro re nata). “To be taken as required” means medication to be taken when needed, eg when a person is in pain or to prevent or mitigate the onset of illness that might otherwise require medical attention or even be life threatening.
Some non-prescribed medication such as common analgesics can also be taken as required, depending on the reasons for its use with or without prescribed medicines.
PRN medicines are those that do not have prescription regimes concerning the times and amounts to be taken on each occasion, but are to be used when the need arises. They include medicines described as “Emergency Use” or “Rescue” medicines, the use of which should follow common principles of medicines administration applied to particular conditions and circumstances.
PRN medication is usually prescribed to treat short-term or intermittent medical conditions or in emergencies and is not to be taken regularly. Painkillers are commonly prescribed on a PRN basis or obtained on an over-the-counter basis.
All such medication will usually have on its patient information leaflet (PIL) the limits in which it can be safely used, in terms of how it should eb administered, amounts and frequency, and whether it might interact adversely with other medication being taken. This information must always be studied and observed.
All users of PRN medicines including emergency use and rescue medicines should closely follow all medical and pharmaceutical advice to understand their purpose and under what circumstances a particular medicine might be used.
Policy Statement
To ensure the medication is given as intended, a specific plan or protocol for administration is recorded in the person’s care plan and kept with their MAR charts. This will state clearly what the medication is for and the circumstances in which it might be given.
For example, a person who has been prescribed a PRN anti-emetic will have an entry to state that the medication is used to treat nausea or vomiting. Staff will then make an assessment to decide whether or not the medication can be given safely. It is important to check with the person what their needs and wishes are.
Records should show that PRN medication is not only offered or given during specific medication rounds but is given or taken whenever the person requires it, ie whenever they are experiencing symptoms. The time the medication is given and the amount given must be recorded on the MAR chart and indicated that it has been given to meet a specific need.
When PRN medication is being given on a regular or increasing basis, or the person appears to be becoming dependent on it, the home will contact the prescriber to review its use. For instance, if a person is taking painkillers more often than formerly this might signal a change in their medical condition. Alternatively, where PRN is no longer required it may need to be discontinued.
All uses of PRN and specific rescue or emergency use medicines will be routinely reviewed to ensure that they have been used correctly and have been effective and that the protocols for their use have been followed. Review outcomes will be recorded with any lessons for future use and changes made to the individual’s PRN / emergency medication plan.
PRN medicines should always be provided in their original packaging complete with label and clear instructions for use.
The home monitors and regularly audits the usage of PRN medication to make sure that it is following current best practice pharmaceutical guidance.
Common Procedures for PRN and Emergency/Rescue Medicines Use
The following procedures provide a common framework for the drawing up of individual PRN care plans and emergency use medicines/ protocols.
- Any PRN or emergency use medicine that has been prescribed or recommended on medical advice must be clearly recorded in the person’s care plan with information on why its use has been authorised.
- Alternatively there should be a separate plan for medicines that require detailed administration instructions , such as for acute or chronic pain management and emergency use
- The care plan / separate plan should include information on:
- why the medicine has been prescribed or made available “as required” /for emergency use
- how it is always available “when required”, including where the medicine is carried with the person for emergency use
- the mode and route of administration eg tablets or liquid, inhaler, or injector with clear instructions on each
- the recommended dose to be taken at any one time, including any repeats
- the minimum time between doses allowable in line with the prescribing instructions/PIL
- the maximum number of doses to be taken in a set period, eg 24 hours
- how the person usually takes the medicine ie can self – administer / needs support or administration by staff / others
- the required competence of the person to self – administer and of any staff / third party to support or administer the medicines and any instruction / training provided
- any difficulties/issues that the person might have in taking the medicine, eg with injections or use of aids like drivers and how they should be addressed if arising
- whether the medicine is safe to use at the time that it is requested/needed (eg will not conflict with any other medicines being taken at the time)
- how any administration should be recorded with instructions to record promptly in order to ensure accuracy
- instructions on any follow up actions eg when to call for emergency medical help and guidance
- instructions on how any adverse incident arising from its use should be reported and will be dealt with.
Training
Care staff are made aware of the policy and procedures on PRN and emergency use medication as part of their induction and further training in safe handling, administration, storage and disposal of all medication and drugs used in the home.
All new staff will receive training as part of their induction covering basic information about common medicines and what constitutes PRN medication.
Those who will be involved in medicines administration will have competency assessments and additional training to the level required by their roles and responsibilities. This will include training relating to the administration of PRN and emergency use medication. All training will reflect up-to-date evidence-based guidelines.
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