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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
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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 

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