Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-19T10:42:53.146Z Has data issue: false hasContentIssue false
  • English
  • Français

The administration of psychotropic PRN medication in Scottish psychiatric intensive care units

Published online by Cambridge University Press:  25 February 2014

Gazala Akram ,
Anton Slavin  and
Paul Davies
Gazala Akram*
Affiliation:
Lecturer, Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, Scotland Specialist Mental Health Pharmacist, NHS Greater Glasgow & Clyde, Scotland
Anton Slavin
Affiliation:
Pharmacist, Co-Op Pharmacy, Edinburgh, Scotland
Paul Davies
Affiliation:
Specialist Mental Health Pharmacist, NHS Greater Glasgow & Clyde, Scotland
*
Correspondence to: Dr G. Akram, University of Strathclyde Pharmacy, 160 Cathedral St, Glasgow G4 0RE. E-mail: gazala.akram@strath.ac.uk
Get access

Abstract

Information concerning the administration of psychotropic PRN medication in Scottish PICUs is scarce. The medical notes and prescription charts of all patients (n = 75) admitted during the study period were consulted to determine the frequency and nature of PRN practice.

65% of patients (n = 49) were administered up to 11 drugs comprising of antipsychotics (n = 8), benzodiazepines (n = 2) and zopiclone. The most frequently administered PRN medicines were lorazepam, haloperidol and zuclopenthixol. The mean dose administered for oral and intramuscular (IM) forms of both lorazepam and haloperidol were very similar. The mean number of PRN administrations per patient per day was 0.4. 40% of psychotropic PRN administrations were initiated by the nurse with the majority of doses administered at bedtime. Ten patients received an IM injection. Four patients were restrained during these administrations. Documentation pertaining to the rationale for IM administrations and of pre and post rapid tranquillisation physical health monitoring was lacking. This study highlights variation in practice between units, inadequate monitoring and documentation, a possible lack of understanding by prescribers of the differences in bioavailability between oral and injectable forms of medication and relatively limited use of newer drugs.

Keywords

As required medicationPRN administrationrapid tranquillisation
Type
Original Research Article
Information
Journal of Psychiatric Intensive Care , Volume 10 , Issue 2 , August 2014 , pp. 64 - 74
Copyright
Copyright © NAPICU 2014 

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., Davies, P. (2014) Characterising the nature of psychotropic medication prescribed in Scottish PICUS. Journal of Psychiatric Intensive Care. First published online February 2014. Doi:10.1017/S1742646414000016.Google Scholar
Allen, M., Currier, G., Hughes, D., Docherty, J., Carpenter, D., Ross, R. (2005) Expert consensus guideline series: Treatment of behavioural emergencies. Journal of Psychiatric Practice. 11(suppl. 1): 5–108.CrossRefGoogle Scholar
Baker, J., Lovell, K., Harris, N. (2007) Mental health professionals’ psychotropic pro re nata medication practices in acute inpatient mental health care. General Hospital Psychiatry. 29: 163–168.Google Scholar
Baker, J., Lovell, K., Harris, N. (2008) A best evidence synthesis review of the administration of psychotropic pro re nata medication in inpatient mental health settings. Journal of Clinical Nursing. 17: 1112–1131.CrossRefGoogle Scholar
Bennett, J., Done, J., Hunt, B. (1995) Assessing the side effects of antipsychotic drugs: a survey of CPN practice. Journal of Psychiatric Mental Health Nursing. 2: 177–182.Google Scholar
Bernard, P., Littlejohn, R. (2000) The use of as required medication on an adolescent psychiatric unit. Clinical Child Psychology & Psychiatry. 5: 258–266.CrossRefGoogle Scholar
Brown, S., Chhina, N., Dye, S. (2010) Use of psychotropic medication in seven English psychiatric intensive care units. Psychiatric Bulletin. 34: 130–135.Google Scholar
Bowden, M.F. (1999) Audit: prescription of ‘as required’ (p.r.n.) medication in an in-patient setting. Psychiatric Bulletin. 23: 413–416.CrossRefGoogle Scholar
Curtis, J., Capp, K. (2003) Administration of as needed psychotropic medication. International Journal of Mental Health Nursing. 12: 229–234.CrossRefGoogle ScholarPubMed
Choke, A., Perumal, M., Howlett, M. (2007) Lorazepam prescription and monitoring in acute adult psychiatric wards. Psychiatric Bulletin. 31: 300–303.Google Scholar
Davis, S., Lennard, M., Ghahramani, P., Pratt, P. (2007) PRN prescribing in psychiatric inpatients: potential for pharmacokinetic drug interactions. Journal of Psychopharmacology. 21: 153–160.Google Scholar
Duxbury, J., Wright, K., Bradley, D., Barnes, P. (2010) Administration of medication in the acute mental health ward: perspective of nurses and patients. International Journal of Mental Health Nursing. 19: 53–61.Google Scholar
Geffen, J., Sorenson, L., Stokes, J., Cameron, A., Roberts, M., Geffen, L. (2002) Pro re nata medication for psychosis: an audit of practice in two metropolitan hospitals. Australian & New Zealand Journal of Psychiatry. 36: 649–656.Google Scholar
Hales, H., Gudjonsson, G. (2004) Effect of ethnic differences on the use of prn (as required) medication on an inner London medium secure unit. The Journal of Forensic Psychiatry & Psychology. 15(2): 303–313.CrossRefGoogle Scholar
Hallahan, B., Murray, I., McDonald, C. (2009) Benzodiazpeine and hypnotic prescribing in an acute adult psychiatric in-patient unit. Psychiatric Bulletin. 33: 12–14.CrossRefGoogle Scholar
Innes, J., Iyeke, L. (2012) A review of the practice and position of monitoring in today's rapid tranquillisation protocols. Journal of Psychiatric Intensive Care. 8: 15–24.Google Scholar
Mental Welfare Commission for Scotland. (2011) Not Properly Authorised: Unannounced visits to people receiving treatment under the safeguards of part 16 of the Mental Health (Care and Treatment) (Scotland) Act 2003. http://www.mwcscot.org.uk/media/52136/Not%20Properly%20Authorised%20Part%2016%2010-11.pdf Google Scholar
National Institute for Clinical Excellence. (2005) Violence: The short term management of disturbed/violent behaviour in inpatient psychiatric settings and emergency departments. NICE Clinical Guideline 25. http://guidance.nice.org.uk/CG25/NiceGuidance/pdf/English Google Scholar
Niroshan Siriwardena, A. (2013) Experimental methods in health research. In: Saks, M., Allsop, J. (eds). Researching Health, 2nd edition. London: SAGE Publications, p. 275.Google Scholar
Paton, C., Barnes, T., Cavanagh, M., Taylor, D., Elliot, P. (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
Stewart, D., Robson, D., Chaplin, R., Quirk, A., Bower, L. (2012) Behavioural antecedents to pro re nata psychotropic medication administration on acute psychiatric wards. International Journal of Mental Health Nursing. 21(6): 540–549.Google Scholar
Scottish Intercollegiate Guidelines Network. (2013) Management of Schizophrenia. Guideline 131. http://www.sign.ac.uk/guidelines/fulltext/131/index.html Google Scholar
Taylor, D., Paton, C., Kapur, S. (2012) The Maudsley Prescribing Guidelines in Psychiatry, 11th edition. London: Wiley-Blackwell.Google Scholar
Thapur, P., Palmer, S., Owen, R., Huntley, A., Clardy, J., Miller, L. (2003) P.R.N. (as-needed) orders and exposure of psychiatric inpatients to unnecessary psychotropic medications. Psychiatric Services. 54: 1282–1286.Google Scholar
Usher, K., Luck, L. (2004) Psychotropic PRN: a model for best practice management of acute psychotic behavioural disturbance in inpatient psychiatric settings. International Journal of Mental Health Nursing. 13: 18–21.Google Scholar
Usher, K., Lindsay, D., Sellen, J. (2001) Mental health nurses’ PRN psychotropic medication administration practices. Journal of Psychiatric Mental Health Nursing. 8: 383–390.Google Scholar