Pro re nata medication for psychoses: the knowledge and beliefs of doctors and nurses.
OBJECTIVE
To examine the knowledge and beliefs of doctors and nurses in inpatient psychiatric units about pro re nata (PRN) (as needed) medications for psychotic disorders.


METHODS
Medical (n = 44) and nursing (n = 80) staff in two metropolitan public hospital units completed a structured questionnaire about their use of PRN psychotropic medications on one occasion during the four months from March-June 1999.


RESULTS
Nurses selected more indications for PRN antipsychotics than doctors (3.49 vs 2.72, p < 0.05), whereas doctors selected more indications for PRN benzodiazepines (3.77 vs 3.19, p < 0.05). The groups did not differ in the number of selected indications for using anticholinergics. For agitation, the majority of nurses viewed both benzodiazepines (56%) and antipsychotics (86%) as effective, with 60% preferring an antipsychotic. For the acute control of psychotic symptoms, 99% of nurses believed antipsychotics were effective and 58% benzodiazepines, with 87% preferring an antipsychotic. A large majority of doctors viewed both PRN benzodiazepines, 94%,and antipsychotics, 81%, as effective for agitation, and 55% preferred to use a benzodiazepine. For psychotic symptoms, 80% believed PRN antipsychotics were effective, but only 32% viewed benzodiazepines as effective, and 64% preferred to use an antipsychotic. Nursing staff identified more non-pharmacological techniques for managing both agitation and psychotic symptoms and reported using these more often than doctors. Junior staff, both nursing and medical, had less knowledge of non-pharmacological alternatives to PRN medication than senior staff.


CONCLUSIONS
Disparities existed between doctors and nurses views on the indications for PRN medication in the acute management of psychoses, thus it is important for doctors to specify indications when writing PRN prescriptions. Despite evidence for the safety and effectiveness of benzodiazepines, there was widespread reluctance to use them as PRN medication in acute psychoses. Beliefs of some staff about PRN medications were at odds with the known properties of these medicines. Educational interventions for both nurses and doctors are required to achieve best practice in PRN medication.
Geffen
Josh
J
Department of Psychiatry, The University of Queensland, Herston, Queensland 4006, Australia. josh_geffen@bigpond.com
Cameron
Allison
A
Sorensen
Lene
L
Stokes
Julie
J
Roberts
Michael S
MS
Geffen
Laurence
L
D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003071:Cognition; D003469:Culture; D003657:Decision Making; D004334:Drug Administration Schedule; D006801:Humans; D009726:Nurses / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data; D011570:Psychiatry; D011618:Psychotic Disorders / Q000188:drug therapy*; D011795:Surveys and Questionnaires
D014150:Antipsychotic Agents