Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-27T23:07:42.312Z Has data issue: false hasContentIssue false
  • English
  • Français

PRN medication: beliefs and practices of psychiatrists and nurses working in PICUs and secure units

Published online by Cambridge University Press:  09 December 2015

Camilla Haw ,
Helen Sasegbon ,
Imadeldin Ismail  and
Malathi Pushpanathan
Camilla Haw*
Affiliation:
St Andrew’s Healthcare, Northampton, UK
Helen Sasegbon
Affiliation:
St Andrew’s Healthcare, Northampton, UK
Imadeldin Ismail
Affiliation:
St Andrew’s Healthcare, Northampton, UK
Malathi Pushpanathan
Affiliation:
St Andrew’s Essex, UK
*
Correspondence to: Professor Camilla Haw, St Andrew’s Academic Centre, St Andrew’s Healthcare, Cliftonville Rd, Northampton NN1 5DG; [email protected]
Get access

Abstract

Introduction

PRN (as required) medication is commonly used in inpatient psychiatry but little is known about staff opinions concerning its use.

Aims & objectives

To explore views about PRN medication among nurses and psychiatrists working in PICUs or secure care at a charitable hospital.

Method

A structured questionnaire with visual analogue scales was used to examine staff views about PRN medication. Participants were: 21 PICU nurses, 20 nurses working on medium secure admission units (MSAUs) and 27 psychiatrists. Inquiry was made about preferences and avoidance of PRN drugs and when PRN administration becomes rapid tranquillisation (RT).

Results

Nurses working in PICUs and MSAUs held similar views about PRN medication. Nurses were more in favour of PRN medication than psychiatrists, whereas psychiatrists felt more strongly that PRN sedation was sometimes over-used. PICU staff favoured promethazine whereas non-PICU staff preferred lorazepam/lorazepam and haloperidol combined. There was no consensus as to when PRN administration becomes RT.

Conclusions

Nurses hold more positive views about PRN sedation than psychiatrists. Despite the ECG requirement, many staff favour haloperidol. The NICE definition of RT was not quoted by most participants. RT and PRN medication is a grey area which deserves further exploration.

Keywords

PRN medicationrapid tranquillisationsurveypsychiatristsnursesPICU
Type
Original Research Article
Information
Journal of Psychiatric Intensive Care , Volume 11 , Supplement S1 , December 2015 , e5
Copyright
Copyright © NAPICU 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akram, G., Slavin, A. and Davies, P. (2014) The administration of psychotropic PRN medication in Scottish psychiatric intensive care units. Journal of Psychiatric Intensive Care. 10: 64–74.CrossRefGoogle Scholar
All-Party Parliamentary Group on Dementia. (2008) Always a last resort: inquiry into the prescriptionof antipsychotic drugs to people with dementia living in care homes. Alzheimer’s Society. http://www.alzheimers.org.uk/site/scripts/download.php?fileID=322.Google Scholar
Baker, J.A., Keady, J., Hardman, P., Kay, J., Jones, L. and Jolley, D. (2010) Psychotropic PRN use among older people’s inpatient mental health services. Journal of Psychiatric & Mental Health Nursing. 17: 463–468.CrossRefGoogle ScholarPubMed
Blom, M.T., Bardai, A., van Munster, B.C., Nieuwland, M., de Jong, H., van Hoeijen, D., Spanjaart, A.M., de Boer, A., de Rooij, S.E. and Tan, H.L. (2011) Differential changes in QTc duration during in-hospital haloperidol use. PLos ONE. 6: e23728.CrossRefGoogle ScholarPubMed
Braun, V. and Clarke, V. (2006) Using thematic analysis in psychology. Qualitative Research in Psychology. 3: 77–101.CrossRefGoogle Scholar
Chakrabarti, A., Whicher, E.V., Morrison, M. and Douglas-Hall, P. (2007) ‘As required’ medication regimens for seriously mentally ill people in hospital. Cochrane Database of Systematic Reviews. 2007(3): CD003441. DOI: 10.1002/14651858. CD003441.pub2.Google Scholar
Curtis, J. and Capp, K. (2003) Administration of ‘as needed’ psychotropic medication: a retrospective study. International Journal of Mental Health Nursing. 12: 229–234.CrossRefGoogle ScholarPubMed
Davies, S.J.C., Lennard, M.S., Ghahramani, P., Pratt, P., Robertson, A. and Potokar, J. (2007) PRN prescribing in psychiatric inpatients – potential for pharmacokinetic drug interactions. Journal of Psychopharmacology. 21: 153–160.CrossRefGoogle ScholarPubMed
Geffen, J., Cameron, A., Sorensen, L., Stokes, J., Roberts, M.S. and Geffen, L. (2002) Pro re nata medication for psychoses: the knowledge and beliefs of doctors and nurses. Australian & New Zealand Journal of Psychiatry. 36: 642–648.CrossRefGoogle ScholarPubMed
Haw, C. and Stubbs, J. (2010) Covert administration of medication to older adults: a review of the literature and published studies. Journal of Psychiatric & Mental Health Nursing. 17: 761–768.CrossRefGoogle ScholarPubMed
Haw, C. and Wolstencroft, L. (2014a) A study of the use of sedative PRN medication in patients at a secure hospital. Journal of Forensic Psychiatry & Psychology. 25: 307–320.CrossRefGoogle Scholar
Haw, C. and Wolstencroft, L. (2014b) The administration of ‘as required’ sedative medication at a secure psychiatric hospital. British Journal of Mental Health Nursing. 3: 57–61.CrossRefGoogle Scholar
Haw, C. and Wolstencroft, L. (2014c) A study of the prescription and administration of sedative PRN medication to older adults at a secure hospital. International Psychogeriatrics. 26: 943–951.CrossRefGoogle Scholar
IBM Corp (2011) IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.Google Scholar
Innes, J. and Sethi, F. (2013) Current rapid tranquillisation documents in the UK: a review of the drugs recommended, their routes of administration and clinical parameters influencing their use. Journal of Psychiatric Intensive Care. 9: 110–118.CrossRefGoogle Scholar
Joint Formulary Committee (2014) British National Formulary, 66th edition. London: BMJ Group & Pharmaceutical Press.Google Scholar
Mental Capacity Act (2005c.9) London: The Staionary Office.Google Scholar
Milton, J., Lawton, J., Smith, M. and Buckley, A. (1998) Hidden high-dose antipsychotic prescribing: effects of p.r.n. doses. Psychiatric Bulletin. 22: 675–677.CrossRefGoogle Scholar
NICE (2005) Violence: The short term management of disturbed/violent behaviour in inpatient psychiatric settings and emergency departments. NICE, CG25. http://www.nice.org.uk/guidance/CG25.Google Scholar
NICE (2014) Rapid tranquillisation in mental health settings: Promethazine hydrochloride. NICE, ESUOM28. https://www.nice.org.uk/advice/esuom28.Google Scholar
Parker, C. (2015) Midazolam for rapid tranquillisation: its place in practice. Journal of Psychiatric Intensive care. 11(1): 66–72. DOI: 10.1017/S1742646413000356.CrossRefGoogle Scholar
Paton, C., Barnes, T.R.E., Cavanagh, M.-R. and Taylor, D. (2008) High-dose and combination antipsychotic prescribing in acute adult wards in the UK: the challenges posed by p.r.n. prescribing. British Journal of Psychiatry. 192: 435–439.CrossRefGoogle ScholarPubMed
Smith, G.M., Davis, R.H., Altenor, A., Tran, D.P., Wolfe, K.L., Deegan, J.A. and Bradley, J. (2008) Psychiatric use of unscheduled medications in the Pennsylvania state Hospital system: effects of discontinuing the use of P.R.N. orders. Community Mental Health Journal. 44: 261–270.CrossRefGoogle ScholarPubMed
Srivastava, A. (2009) Limited evidence for the effectiveness of P.R.N. medications among psychiatric inpatients. Journal of Psychiatric Practice. 15: 193–201.CrossRefGoogle ScholarPubMed
Stewart, D., Robson, D., Chaplin, R., Quirk, A. and Bowers, L. (2012) Behavioural antecedents to pro re nata psychotropic medication administration on acute psychiatric wards. International Journal of Mental Health Nursing. 21: 540–549.CrossRefGoogle ScholarPubMed
Thapa, P.B., Palmer, S.L., Owen, R.R., Huntley, A.L., Clardy, J.A. and Miller, L.H. (2003) P.R.N. (as needed) orders and exposure of psychiatric inpatients to unnecessary psychotropic medications. Psychiatric Services. 54: 1282–1286.CrossRefGoogle ScholarPubMed
TREC Collaborative Group (2003) Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine. BMJ. 327: 708–713.CrossRefGoogle Scholar
Usher, K., Lindsay, D. and Sellen, J. (2001) Mental health nurses’ PRN psychotropic medication administration practices. Journal of Psychiatric & Mental Health Nursing. 8: 382–390.CrossRefGoogle ScholarPubMed
Usher, K., Baker, J.A., Holmes, C. and Stocks, B. (2009) Clinical decision-making for ‘as needed’ medications in mental health care. Journal of Advanced Nursing. 65: 981–991.CrossRefGoogle ScholarPubMed