PRN psychotropic medications: The need for nursing research
Kim Usher
School of Nursing, Midwifery and Nutrition, James Cook University, Cairns QLD
Colin Holmes
Professor, School of Nursing, Midwifery and Nutrition, James Cook University, Townsville QLD
David Lindsay
School of Nursing Sciences, James Cook University, Townsville QLD
Lauretta Luck
School of Nursing and Midwifery, Family and Community Health Research Group, University of Western Sydney, Penrith NSW
PP: 248 - 257
Abstract
This paper highlights the inadequacy of existing research for the purposes of evidence-based prn (Latin, pro re nata or 'as needed') medication practice in psychiatric settings and notes the absence of relevant evidence-based clinical practice guidelines and policies, both nationally and internationally.
The professional, ethical and legal importance of PRN medication practices is also discussed, and shown to add to the urgency of developing a research agenda which will serve as an adequate basis for good clinical practice.
This paper summarises the relevant research and identifies problems that can arise for clinicians involved in the administration of prn medications in mental health settings. It concludes by highlighting key issues which urgently require empirical investigation.
Keywords
prn medication; psychotropics; nursing practice; evidence-based practice; clinical guidelines
References
Allen, M.H. (2000): Managing the agitated psychotic patient: A reappraisal of the evidence. Journal of Clinical Psychiatry 61: 11-20.
Ayd, F.J. (1985): Problems with orders for medications as needed. American Journal of Psychiatry 142: 939-942.
Bennett, J., Done, J. & Hunt, B. (1995): Assessing the side effects of antipsychotic drugs: A survey of CPN practice. Journal of Psychiatric and Mental Health Nursing 2: 177-182.
Bernard, P. & Littlejohn, R. (2000): The use of 'as required' medication on an adolescent psychiatric unit. Clinical Child Psychology and Psychiatry, 5(2): 258-266.
Bowden, M.F. (1999): Audit: Prescription of 'as required' (prn) medication in an in-patient setting. Psychiatric Bulletin, 23(7): 413-416.
Buckley, P.F. (1999): The role of typical and atypical antipsychotic medications in the management of agitation and aggression. Journal of Clinical Psychiatry 60: 52-60.
Carson,V. B. (2000): Mental Health Nursing: The Nurse-Patient Journey, W.B. Saunders, Philadelphia.
Cook, H.G. (2000): Nurses' knowledge and perception of psychotropic medications in long-term care facilities. Unpublished MSN thesis, Gonzaga University, Spokane, Washington, USA.
Craven, J., Voore, P. & Voineskos, G. (1987): PRN medication in psychiatric inpatients. Canadian Journal of Psychiatry, 32: 199-203.
Demczar, D. & Levin, G.M. (1996): Use of atypical antipsychotics on an as-needed basis. Journal of Pharmacy Technology 12: 145-148.
Douzjian, M., Wilson, C., Shultz, M., Berger, J., Tapnio, J. & Blanton, V. (1998): A program to use pain control medication to reduce psychotropic drug use in residents with difficult behavior. Annals of Long-Term Care 6(5): 174-179.
Edginton, J. (1995): Law for the Nursing Profession and Allied Health Care Professionals. CCH, Australia.
Fishel, A.H., Ferreiro, B.W., Rynerson, B.C., Nickell, M., Jackson, B. & Hannon, B.D. (1994): As needed psychotropic medications: Prevalence, indications and results. Journal of Psychosocial Nursing 32(8): 27-32.
Geffen, J., Sorensen, L., Stokes, J., Cameron, A., Roberts, M.S. & Geffen, L. (2002): Pro re nata medication for psychoses: an audit of practice in two metropolitan hospitals. Australian and New Zealand Journal of Psychiatry, 36: 649-656.
Gray, R.J. & Smedley, N. (1996): Administration of PRN medication by mental health nurses. British Journal of Nursing 5(21): 1317-1322.
Gray, R.J., Smedley, N. & Thomas, B. (1997): The administration of PRN medication by mental health nurses. Journal of Psychiatric and Mental Health Nursing 4(1): 55-56.
Jablensky, A., McGrath, J., Hermann, H., Castle, D., Gureje, O., Morgan, V. & Korten, A. (1999): People living with psychotic illness: an Australian study 1997-98. Report 4. National Survey of Mental Health and Wellbeing. Commonwealth Department of Health and Aged Care, Canberra.
Kaplan, S.L. & Busner, J. (1997): The use of PRN and stat medication in three child psychiatric inpatient settings. Psychopharmacology Bulletin 33(1): 161-164.
Keltner, N.L. & Folks, D.G. (1997): Psychotropic Drugs, 2nd ed, Mosby, St Louis.
McKenzie, A., Kudinoff, T., Benson, A. & Archillingham, A. (1999): Administration of PRN medication: a descriptive study of nursing practice. Australian and New Zealand Journal of Mental Health Nursing 8: 187-191.
Milton, J., Lawton, J., Smith, M. & Buckley, A. (1998): Hidden high-dose antipsychotic prescribing: Effects of p.r.n. doses. Psychiatric Bulletin 22(11): 675-677.
Newton, K.L., Murthy, R. & Qureshi, J. (1997): Antipsychotic prescribing in light of the consensus statement of the College. Psychiatric Bulletin 21(7): 408-410.
Parker, G., Lambert, T., McGrath, J., McGorry, P. & Tiller, J. (1998): Neuroleptic management of schizophrenia: a survey and commentary on Australian psychiatric practice. Australian and New Zealand Journal of Psychiatry, 32: 50-58.
Power, P., Elkins, K. Adlard, S., Curry, C., McGorry, P. & Harrigan, S. (1998): Analysis of the initial treatment phase in first-episode psychosis. British Journal of Psychiatry Supplement, 172(33): 71-76.
RANZCP Committee on Psychotropic Drugs and Other Physical Treatments. (1999): Response to 'Cardio-toxicity associated with the use of intravenous haloperidol' (letter). Australian and New Zealand Journal of Psychiatry, 33: 943-944.
Royal College of Psychiatrists (1998): Management of imminent violence: clinical practice guidelines to support mental health services. Text available at: http://www.psychiatry.ox.ac.uk/cebmh/guidelines/violence/violence_full.html
Sheline, Y. & Nelson, T. (1993): Patient choice: deciding between psychotropic medication and physical restraints in an emergency. Bulletin of the American Academy of Psychiatry and Law 21(3): 321-9.
Tobias, D.E. & Pulliam, C.C. (1997): General and psychotherapeutic medication use in 878 nursing facilities: A 1997 national survey. The Consultant Pharmacist, 12: 1401-1408.
UKCC (2002): The Recognition, Prevention and Therapeutic Management of Violence in Mental Health Care; a Summary. London: United Kingdom Central Council for Nursing, Midwifery and Health Visiting.
Usher, K., Lindsay, D. & Sellen, J. (2001): Mental health nurses' PRN psychotropic medication administration practices. Journal of Psychiatric and Mental Health Nursing 8(5): 383-390.
Walker, R. (1991): PRN psychotropic drug use on a psychiatric unit. Psychiatric Quarterly 62(1): 1-8.
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