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Quantifying unused orders for as-needed medications.

T W Woller, D H Kreling, P A Ploetz

    American Journal of Hospital Pharmacy
    |June 1, 1987
    PubMed
    Summary
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    Many as-needed (p.r.n.) medication orders are unused in hospitals. This study found 62% of p.r.n. orders were not used, particularly those written on admission or for short stays.

    Area of Science:

    • Pharmacology
    • Hospital Pharmacy Practice
    • Health Services Research

    Background:

    • As-needed (p.r.n.) medications are frequently prescribed in hospital settings.
    • The extent of nonuse of these orders and factors influencing it are not well-quantified.
    • Understanding p.r.n. order utilization is crucial for optimizing medication management and patient care.

    Purpose of the Study:

    • To quantify the nonuse of as-needed (p.r.n.) medication orders in a university hospital.
    • To identify specific therapeutic categories and patient populations with high rates of unused p.r.n. orders.
    • To provide recommendations for reducing the nonuse of p.r.n. medications.

    Main Methods:

    • Retrospective chart review of 882 patients admitted during the last six months of 1984.

    Related Experiment Videos

  • Random selection of seven patients per month from 21 medical-surgical services.
  • Quantification of p.r.n. orders by therapeutic category and admission timing; determination of use/nonuse via pharmacy records.

    • Main Results:

    • Out of 7735 p.r.n. orders reviewed, 4793 (62%) were unused.
    • Antacids, despite being least prescribed, showed the highest nonuse rate.
    • Unused order rates were higher for admission-day orders (vs. subsequent orders) and for patients with shorter hospital stays (80% nonuse for stays ≤2 days).

    Conclusions:

    • A significant proportion of as-needed medication orders are not utilized in university hospitals.
    • Focusing on reducing admission-day orders and addressing short-stay patient needs can improve p.r.n. medication utilization.
    • Optimizing p.r.n. prescribing practices can enhance medication safety and resource allocation.