Medicines prescribed when required – a good practice guide for care homes

For all staff responsible for for administering PRN medicines in care homes.

You can download a full pdf version of this document by following the link on the right.

What is ‘when required’ medication (PRN)?

It’s medication not required by the resident on a regular basis. It’s usually prescribed to treat short term or intermittent medical conditions, sometimes with varying dosages, for example 1 or 2 tablets every 4 to 6 hours.

PRN medications are not restricted to the times of medication administration rounds. They should be administered ‘as and when’ required. This may be at the resident’s request and/or when care home staff decide that the medication is clinically required.

Some common examples of prescribed PRN medications include analgesics, laxatives, and sedatives.

Aim or purpose

To support safer administration of PRN medications and highlight key issues to consider when care home staff administer a PRN medication.

Recommendations

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.

Contact the prescriber if there are any issues about the medication.

Use a personalised PRN template for all when required medications

See appendix 1 in the pdf on the right. This should be kept with the residents Medication Administration Record (MAR) charts.

Include the following information on the PRN template (see example in Appendix 2 and 3)

The name of the resident
Route of the medicine (for example, oral)
Dose
Frequency
Minimal time interval between doses
Maximum number of doses in 24 hours
What the medicine is for (indication)
Alternative strategies to be attempted before a medication is administered as stated in the care plan (for example, prunes for constipation)
The resident’s awareness of symptoms
The resident’s capacity to request or refuse the medication as per a mental capacity assessment.
Symptoms/ cues to look for, which may be verbal or non-verbal, for example, expressions of distress
When to offer and how to give the medication, for example, if medication needs to be given covertly. Refer to the covert medicines guidance for care homes
State clearly in which order medications must be administered when there’s more than one option and time interval in between them. For example, multiple painkillers, or seizure medicines such as diazepam, midazolam.
The outcome of giving the medication and whether or not it was effective.

Administration of PRN medications

Offer some PRN medications routinely throughout the day

This should happen not only at medication rounds

Don’t offer PRN medication more frequently than prescribed

It’s important to note the minimum interval between doses and the maximum dose in 24 hours.

Record each medication round

It’s good practice to do this at each medication round. If you give the PRN medication, you must record the:

number of tablets/dose given especially when there’s a varying dose (for example, 1 to 2 tablets). There must be clear instructions on whether 1 or 2 tablets are given and a description of how you reached this decision.
exact time of administration to make sure the required time interval has passed before administering the next dose.

This will help to avoid

Monitor the resident and record their response to medicine

Contact the GP if the resident:

experiences side effects
doesn’t benefit from the medication
asks for medication more frequently than usual
asks for the PRN medication more frequently than prescribed
shows signs of their medical condition deteriorating
rarely requests or regularly declines

If PRN medication is left over at the end of the monthly cycle

If it’s still in date then this should be ‘carried forward’ from one month to the next.. This will avoid unnecessary medicines waste.

Refer to reducing medicines 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.

Review the PRN medication routinely

The review date should be clearly stated.

Ordering, storage and disposal of PRN medication

Order stocks of PRN medicine to maintain adequate stock levels

This will help to meet the resident’s changing demands.

Carry over PRN medication if it is still needed and hasn’t expired

Order only if the drug will expire before the next ordering cycle.

If a resident needs PRN medication, the paper/eMAR must reflect this

This must happen even if it’s not ordered, provided there’s sufficient stock in the care home. Contact the community pharmacy to confirm that PRN medication is still required, and the reason it’s not ordered as there’s adequate stock.

PRN medication must be stored in its original package

This should include the pharmacy dispensing label attached. It allows the expiry date to be checked, reducing unnecessary waste.

PRN medication should be readily available to the resident upon request

For example, the resident may choose to have their salbutamol inhaler or GTN spray close by. The care home policy and procedures should guide the risk assessment of each individual’s needs. A balance must be made between accessibility and safety.

Notify the community pharmacy if any PRN medication has been discontinued as authorised by clinicians

Dispose of any expired or stopped PRN medication

This includes when medication is stopped by a clinician. Disposal must happen in accordance of the care home medicines policy.

References

View appendices 1 to 3 and download a full pdf version of this information by following the link on the right.