Use of Psychotropic Medication on a Psychogeriatric Unit: Focusing on "As-Needed" Orders

Objective To evaluate the characteristics of psychotropic medication use under pro re nata (PRN, or "as needed") orders for patients treated in a psychogeriatric hospital ward. Design A retrospective point-prevalence, cross-sectional study comparing PRN order parameters with standards published by the Australian Commission on Quality and Safety in Health Care. Setting An inpatient psychogeriatric unit in a South Australian public teaching hospital. Participants Data were collected from inpatient charts and case notes during a single, continuous 24-hour sampling period. All PRN medication orders were reviewed, including documentation of actual drug administrations, and these were matched with the associated clinical outcomes. Data were collected from 26 patients, for whom a total of 38 PRN psychotropic medication orders were analyzed. Result The majority of PRN orders (81%) met the criteria of the relevant Australian National Standards; however, of the 19 medication administration occasions, only 26% had adequate documentation that included both specific reasons for administration and the outcomes associated with the PRN treatment. Overall, it was noteworthy that a relatively high proportion of these PRN orders (61%) were actioned during the 24-hour snapshot period. Conclusion The use of PRN psychotropic medications remains an important component in the treatment of older patients with mental illness. Continued efforts to improve and optimize the documentation associated with PRN psychotropic drug administration warrant ongoing attention.