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Registration Number: {{org_field_registration_no}}

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PRN Medication Management Policy

1. Purpose

This policy ensures that ‘when required’ (PRN) medicines are managed safely and effectively at {{org_field_name}} in line with the CQC guidance for adult social care, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (including Regulation 12 – Safe care and treatment and Regulation 17 – Good governance), relevant medicines legislation (including the Human Medicines Regulations 2012 and, where applicable, controlled drugs legislation), and NICE guidance on managing medicines in care homes. It aims to ensure that PRN medication is administered appropriately, recorded accurately, and reviewed regularly to support the well-being of people we support.

2. Scope

This policy applies to all staff involved in the prescribing, administration, storage, documentation, and review of PRN medication at {{org_field_name}}. It ensures that PRN medication is used appropriately and in a way that maximises its therapeutic benefits while minimising risks, including overuse or underuse.

3. Related Policies

• Medication Management and Administration Policy (CH21)
• Safe Care and Treatment Policy (CH11)
• Risk Management and Assessment Policy (CH18)
• Person-Centred Care Policy (CH07)
• Mental Capacity and Deprivation of Liberty Safeguards Policy (CH39)
• Safeguarding Adults from Abuse and Improper Treatment Policy (CH13)
• Management of Accidents, Incidents, and Near Misses Policy (CH24)
• Duty of Candour Policy (CH35)
• Record Keeping and Documentation Policy (CH47)
• Good Governance Policy (CH04)

4. Policy Statement

{{org_field_name}} is committed to ensuring that PRN medication is used in a way that is:

• Clinically appropriate: Only administered when necessary based on assessed needs.
• Person-centred: Based on individual care plans and preferences.
• Legally compliant: Adhering to national legislation and regulatory standards.
• Well-documented: With clear recording and audit trails to prevent misuse.
• Regularly reviewed: To ensure effectiveness and appropriateness.

5. PRN Medication Assessment and Authorisation

• PRN medication must be prescribed by a qualified healthcare professional and recorded in the individual’s Medication Administration Record (MAR).
• A detailed PRN protocol must be developed, including:
  • Indications for use (specific symptoms or conditions it treats).
  • Minimum time intervals between doses.
  • Maximum daily dosage.
  • Monitoring requirements (side effects, effectiveness).
  • Alternative strategies before administration.

PRN care plan requirement: For each PRN medicine, a person-centred PRN plan must be in place within the individual’s care plan (and/or eMAR/PRN protocol template) so that staff can administer the medicine exactly as intended by the prescriber. The PRN plan must state:

• the specific condition/symptom the medicine is for and how staff will recognise/measure it (for example: pain score tool; bowel chart trigger; anxiety scale; respiratory symptoms);
• when NOT to administer (red flags/contraindications relevant to the person, including known allergies/sensitivities and when symptoms indicate urgent medical review);
• when to escalate for clinical advice (for example: no effect after the expected onset time; repeated use beyond agreed threshold; worsening symptoms; suspected adverse reaction);
• the expected outcome and the timeframe in which effectiveness will be checked and recorded; and
• any person’s preferences (how they prefer to take the medicine; what has worked before; preferred non-pharmacological strategies).

No ambiguous directions: PRN medicines must not be administered if the prescription/MAR direction is unclear (for example, “as directed” with no protocol). Staff must seek clarification from the prescriber/pharmacy and ensure the PRN plan is updated before administration.

6. Administration of PRN Medication

• PRN medication must only be administered by trained staff who have completed medication administration training.
• Before administration, staff must:
  • Confirm the need for the medication by assessing symptoms.
  • Check the individual’s MAR chart and PRN protocol.
  • Gain verbal consent where possible and respect individual preferences.
  • Ensure correct dosage and administration route.

Where the PRN medicine is a controlled drug, staff must follow the Controlled Drugs SOPs, including witnessed checks where required by the service SOP, and immediate entry into the controlled drugs register with a running balance in accordance with the home’s governance arrangements.

• Record the administration in the MAR chart and daily notes.
• Monitor and document the effectiveness of the medication.

In addition to the ‘rights’ of medicines administration, staff must confirm that the PRN request/need matches the individual PRN plan (Section 5), check for any recent PRN doses to prevent dose stacking, and verify any relevant monitoring parameters before and after administration (for example: sedation score, respiratory rate, blood pressure where required by the protocol, pain score).

7. Record Keeping and Documentation

• Each PRN administration must be recorded in the MAR chart, including:
  • Time and date of administration.
  • Dosage and route given.
  • Reason for administration.
  • Outcome and effectiveness of the medication.
• Records must be complete, legible, contemporaneous and auditable, and kept securely for each person receiving medicines support. This includes ensuring the MAR (paper or electronic) clearly links PRN administration to the individual PRN plan, and that staff record the effectiveness check at the time stated in the PRN plan (for example: ‘pain reduced from 7/10 to 3/10 after 45 minutes’ or ‘no effect – escalated to GP/out-of-hours’).
• If PRN medication is not administered despite being prescribed, a clear record must be made, including the reason (e.g., refusal, alternative interventions used).
• Regular audits must be conducted to ensure compliance with documentation standards.

8. Storage and Security of PRN Medication

• PRN medications must be stored securely in a locked medication cupboard in line with the Medication Management Policy (CH21).
• Controlled drugs (CDs) prescribed as PRN must be stored in the CD cabinet and recorded in the CD register.
• Unwanted, discontinued or out-of-date controlled drugs must be segregated from current stock and stored securely in line with the Controlled Drugs SOPs until disposal/return. Disposal/return must be recorded in the controlled drugs register and signed by the person making the entry and a second suitably trained person as witness. Where the service does not have lawful on-site destruction arrangements, controlled drugs must be returned to the supplying pharmacy in line with local SOPs.
• Expiry dates must be monitored, and expired medication must be disposed of safely following pharmacy guidelines.

9. Review and Monitoring of PRN Medication

• PRN medication must be reviewed regularly, including:
  • Weekly monitoring by staff for usage trends.

Where PRN use exceeds the threshold defined in the PRN plan (for example, repeated use on consecutive days, or more than X administrations in 7 days), the senior/manager must initiate an early clinical review (GP/pharmacist/specialist as appropriate) to consider: underlying causes, non-pharmacological alternatives, dose/formulation changes, and whether a regular medicine is now indicated.

• Monthly medication reviews with the GP or prescribing healthcare professional.

PRN medicines that affect alertness/behaviour (for example sedatives, anxiolytics, antipsychotics) must be explicitly time-limited, reviewed more frequently where required, and must not be used as a substitute for a behaviour support plan.

• Annual full medication review as part of care planning.
• If PRN medication is used frequently, a care plan review must be conducted to assess whether regular medication or alternative treatment is required.

10. PRN Medication for Individuals with Limited or No Capacity

• Where an individual lacks capacity to request PRN medication, the decision must be based on:
  • Observed symptoms.
  • Best-interest decisions in line with the Mental Capacity Act 2005.
  • Consultation with healthcare professionals, family members, or advocates.

Where PRN medicines may have a sedative or restrictive effect, staff must ensure the decision is lawful and least restrictive by completing and recording: a Mental Capacity Act 2005 capacity assessment (decision-specific), a best-interests decision (with appropriate involvement of family/advocates and relevant professionals), and a clear record of why the action is necessary and proportionate. If the overall care and supervision arrangements (including repeated restrictive interventions) may amount to a deprivation of liberty, this must be reviewed under the current legal framework (DoLS remains in force; Liberty Protection Safeguards are not yet implemented and are subject to further national consultation).

11. PRN Medication and Behavioural Management

• PRN medication must not be used as a routine method of managing behaviours that challenge.
• Non-medication strategies (e.g., de-escalation techniques, distraction, environmental adjustments) must be attempted first.
• PRN medication for behavioural support must:
  • Have a clear protocol agreed with the GP or psychiatrist.
  • Be time-limited and subject to frequent review.
  • Be documented with specific reasons for use and effectiveness assessment.

12. Refusal and Covert Administration (PRN or regular medicines)

People have the right to refuse medicines where they have capacity to make that decision. Refusals must be recorded on the MAR and in daily notes, along with any immediate actions taken (for example, re-offer strategy agreed in the care plan, monitoring, escalation for clinical advice where required).

Covert administration (giving medicines disguised in food/drink without the person’s knowledge) must never be used where the person has capacity to consent. Where the person lacks capacity and covert administration is being considered, it must be agreed through a recorded best-interest decision involving the prescriber, care staff, and family/advocate (and pharmacy input where needed), with clear documentation of who was involved and what was agreed. Any crushing or altering of medicines must be checked with a pharmacist because it can change therapeutic effect and safety.

13. Staff Training and Competency Assessment

• All staff administering PRN medication must complete medication management training.
• Additional PRN-specific training is required for medications with complex administration requirements (e.g., pain relief, sedatives, anti-anxiety medication).
• Staff competency is assessed annually through medication audits and direct observation.

14. Handling PRN Medication Errors

• Any errors in PRN medication administration (e.g., wrong dosage, missed dose, incorrect recording) must be reported immediately following the Incident Management Policy.
• Affected individuals must be monitored for adverse effects.
• A root cause analysis must be conducted to prevent recurrence.

Where an error results in, or has the potential to result in, moderate/severe harm, the manager must ensure actions meet statutory and regulatory requirements, including Duty of Candour (open communication with the person and/or their representative, apology where appropriate, and written follow-up) and any required external reporting routes (for example safeguarding referral, GP/NHS 111 advice, emergency services, and CQC notifications in line with the home’s Notification Policy).

All errors, near misses and trends in PRN use must be reviewed through governance systems (audit, learning actions, competency review) to meet Regulation 17 – Good governance.

15. Family and Advocate Involvement

• Families and advocates must be informed of PRN protocols, especially for individuals who require assistance in decision-making.
• Family members’ concerns regarding PRN medication use must be recorded and addressed in care plan reviews.

16. Policy Review

This policy will be reviewed annually or sooner if CQC guidance, legislative updates, or operational needs require an update.

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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}}
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