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Care Homes: Medicines when required

Good Practice Guidance for Care Homes

Medications prescribed ‘when required’ (PRN)

For all staff responsible for administering PRN medicines in care homes

‘When Required’ (PRN) medication is that which is not required by the resident on a regular basis. It is usually prescribed to treat short term or intermittent medical conditions, sometimes with varying dosages e.g. 1 or 2 tablets every 4 to 6 hours.
Aim or Purpose
To support safer administration of PRN medications and highlight key issues to consider when care home staff administer a PRN medication.
 To ensure that the PRN medication is administered as intended by the prescriber, the residents care plan should contain a clear indication for treatment and intended outcomes. The prescriber should be contacted if there are any issues in regards to the medication. The recommendations are:

  • Use a personalised PRN template for all ‘when required’ medications. (Appendix 1) This should be kept with the residents Medication Administration Record (MAR) charts
  • The information on the  PRN template should include the following (see example in Appendix 2):
    • Alternative strategies to be attempted before a medication is administered as stated in the care plan
    • The resident’s awareness of symptoms
    • The resident’s capacity to request medication
    • The resident’s capacity to request or refuse the medication
    • Symptoms to look for,  eg non-verbal expressions of distress
    • The reason why the medication is being administered
    • When to offer and how to give the medication, eg if medication needs to be given covertly. Refer to CCG Guidance: Covert Medicines Guidance
    • State clearly in which order medications are to be administered when there is more than one option and time interval  in between them e.g. multiple painkillers, or seizure medicines e.g diazepam, midazolam)
    • The outcome of giving the medication and whether or not it was effective
  • Some PRN medications should be offered routinely throughout the day and not only at medication rounds
  • PRN medication should not be offered more frequently than prescribed. It is important to note the minimum interval between doses and the maximum dose in 24 hours
  • It is good practice to record at each medication round that the resident has been offered the medication. If the PRN medication is given, the following details should be recorded to prevent incident or accidental overdose:
    • Number of tablets/ dose given especially when there is a varying dose(e.g. 1-2 tablets). There must be clear instructions on whether 1 or 2 tablets are given and a description of how this decision was reached.
    • The exact time of administration to make sure the required time interval has passed before administering the next dose
  • Monitor the resident and record the residents response to the medicine. Contact the GP for advice or review if the resident(s):
    • Appears to be experiencing side effects
    • Appears not to benefit from the medication
    • Requests it more frequently than usual
    • Requests the PRN medication more frequently than prescribed
    • Medical condition has deteriorated
    • Rarely request or regularly declines the PRN medication
  • PRN medicines should be stored securely and accessible on request. They should be kept  in original packaging with pharmacy label on the medicine
  • Keep appropriate stock levels to meet the residents changing needs
  • If PRN medication is left over at the end of the monthly cycle and it is still in date then this should be ‘Carried forward’  from one month to the next.. This will  avoid unnecessary medicines waste. Refer to CCG Guidance: Reducing Medicines/Dressings/Appliances Waste in Care Homes
  • The quantity of PRN medicines ‘carried forward’ should be recorded on the new MAR chart so there is an accurate record of the stock level which will help when undertaking audits
  • The PRN medication should be reviewed routinely and the review date clearly stated

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