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PRN Medication Management Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} manages PRN (Pro Re Nata) medications efficiently and safely, ensuring that they are administered correctly in accordance with prescriber instructions, service user needs, and regulatory requirements. PRN medication refers to medicines that are given as needed, rather than at scheduled times.

This policy ensures compliance with:

• The Regulation and Inspection of Social Care (Wales) Act 2016 – Sets out regulatory requirements for the safe management of medications【32】.
• The Social Services and Well-being (Wales) Act 2014 – Ensures that care services promote the well-being and independence of service users.
• The NICE Guidelines for Managing Medicines in Care Settings (NG67) – Provides best practice recommendations for safe medication administration.
• Care Inspectorate Wales (CIW) Regulations – Requires robust medication management policies to ensure compliance【35】.
• The Medicines Act 1968 – Governs the supply, administration, and storage of medicines.

2. Scope

This policy applies to:

• All employees, including care workers, managers, and administrative staff involved in medication management.
• Service users receiving PRN medication as part of their care plan.
• Prescribers, pharmacists, and external healthcare professionals who support medication administration.

It covers:

• Definition and purpose of PRN medication.
• PRN assessment, recording, and administration procedures.
• Roles and responsibilities of staff.
• Training and competency requirements.
• Monitoring, review, and regulatory compliance.

3. Definition and Purpose of PRN Medication

PRN medication is prescribed for:

• Pain relief (e.g., paracetamol, ibuprofen).
• Anxiety or agitation (e.g., lorazepam, diazepam).
• Nausea and vomiting (e.g., metoclopramide).
• Constipation (e.g., laxatives).
• Short-term conditions (e.g., antihistamines for allergic reactions).

PRN medications must only be administered when necessary and must follow strict assessment and documentation procedures.

4. PRN Medication Assessment and Care Planning

Before PRN medication is administered, a detailed assessment must be completed to determine:

• The purpose of the medication and expected outcomes.
• When it should be administered (specific symptoms or triggers).
• Minimum and maximum dosage and time intervals.
• Any contraindications, side effects, or drug interactions.

Each service user receiving PRN medication must have a PRN Protocol included in their care plan, specifying:

• The name of the medication.
• The indication for use (e.g., for breakthrough pain or distress).
• The minimum time interval between doses.
• The maximum dosage within 24 hours.
• Alternative non-medication interventions that should be tried first (if applicable).
• Service user preferences regarding PRN medication (if they can communicate their needs).

5. Administration of PRN Medication

5.1 Decision-Making Before Administration

Before administering PRN medication, staff must:

• Assess whether the medication is required by checking symptoms against the care plan.
• Consult the MAR (Medication Administration Record) to ensure the required time interval has passed.
• Gain consent from the service user before administration (unless they lack capacity).
• Seek advice from a healthcare professional if unsure.

5.2 Administering PRN Medication

• PRN medication must be given at the lowest effective dose.
• The route of administration (oral, topical, inhaled) must be followed as per the prescription.
• If the service user refuses the medication, this must be recorded on the MAR chart, and an alternative intervention should be considered.
• Staff must stay with the service user to monitor any immediate side effects.

5.3 Recording PRN Administration

After administering PRN medication, staff must document the following in the MAR chart:

• Date and time of administration.
• Dose given.
• Reason for administration (e.g., pain score, visible discomfort).
• Service user response (e.g., whether the medication was effective).
• Any side effects observed.

6. Roles and Responsibilities

6.1 Responsibilities of the Registered Manager

• Ensure that PRN policies and procedures are implemented and followed.
• Oversee staff training and competency assessments.
• Ensure regular reviews of PRN medication use in line with regulatory requirements.
• Ensure PRN medication stock is correctly stored and disposed of when expired.

6.2 Responsibilities of Care Workers

• Follow PRN medication protocols and only administer PRN medications as per prescription.
• Assess and document when and why PRN medication is needed.
• Monitor for adverse reactions or effectiveness of medication.
• Report any medication concerns to the Registered Manager or healthcare professionals.

6.3 Responsibilities of Healthcare Professionals (GPs, Pharmacists)

• Prescribe PRN medication with clear instructions on dosage and frequency.
• Provide guidance on side effects, contraindications, and interactions.
• Support medication reviews and changes as needed.

7. Storage and Disposal of PRN Medication

• All PRN medication must be stored securely in a locked cabinet, separate from general household items.
• Temperature control measures must be followed for refrigerated medications.
• Expired or discontinued PRN medication must be returned to the pharmacy for safe disposal.

8. Staff Training and Competency

• All staff must complete mandatory medication training before administering PRN medication.
• Staff must undergo annual refresher training covering:
  • Safe handling and storage of medication.
  • Correct administration procedures.
  • PRN medication protocols and documentation.
  • Identifying and reporting side effects.
• Competency assessments are conducted regularly to ensure staff adhere to best practices.

9. Monitoring and Compliance

9.1 Reviewing PRN Medication Use

• PRN medication usage must be reviewed monthly to assess:
  • Effectiveness of the medication (e.g., is it working as expected?).
  • Frequency of use (e.g., is it being overused or underused?).
  • Changes in the service user’s condition requiring medication adjustments.
• Any patterns of increased use or concerns regarding dependency must be reported to the prescribing GP.

9.2 CIW Inspections and Compliance

• Care Inspectorate Wales (CIW) will assess PRN medication practices during inspections【35】.
• Medication audits will be conducted internally to ensure adherence to best practices.
• Any medication errors or near misses must be reported and investigated, with corrective actions taken.

10. Related Policies

This policy should be read in conjunction with:

• Medication Management and Administration Policy (DCW21).
• Safeguarding Adults from Abuse and Improper Treatment Policy (DCW13)【34】.
• Confidentiality and Data Protection (GDPR) Policy (DCW34).
• Risk Management and Assessment Policy (DCW18).

11. Policy Review

This policy will be reviewed annually or sooner if required by legislative changes, CIW regulations, or operational needs.

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