title: The impact of a good practice manual on professional practice associated with psychotropic PRN in acute mental health wards: an exploratory study.
abstract: BACKGROUND
  As required or pro re nata (PRN) psychotropic medicines are frequently used in acute mental health wards. PRN is known to contribute to polypharmacy and high doses of antipsychotic medication. Few studies have attempted to improve clinician's use of these potentially harmful drugs.
  
  
  OBJECTIVE
  The objectives of the study were to determine the impact and acceptability of a good practice manual on prescribing and administration practices of PRN psychotropic medication in acute mental health wards.
  
  
  METHODS
  The study used a pre-post exploratory design with two acute mental health wards in the NW of England.
  
  
  RESULTS
  Over the total trial period of 10 weeks, 28 of 35 patients received 484 doses of PRN. Patients had a mean of 3.6 prescriptions of 14 different PRN medications in 34 different dose combinations prescribed. Medication errors beyond poor quality of prescribing occurred in 23 of the 35 patients (65.7%). Prescription quality improved following the introduction of the intervention but quality of nursing notes reduced. Acceptability of the manual to both nursing and medical staff was high.
  
  
  CONCLUSIONS
  The introduction of the manual appeared to influence some of the practices associated with the prescribing and administration of PRN psychotropic medications. Further, larger, more robust studies are required in this area. In particular research is required to identify the reasons why professionals continue to rely so heavily on using PRN medication.
authors.affiliation: The School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, M13 9PL, UK. john.a.baker@manchester.ac.uk
authors.forename: J A
authors.initials: JA
authors.lastname: Baker
authors.forename: K
authors.initials: K
authors.lastname: Lovell
authors.forename: N
authors.initials: N
authors.lastname: Harris
mesh_terms: D001291:Attitude of Health Personnel; D019985:Benchmarking / Q000458:organization & administration*; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D011307:Drug Prescriptions / Q000451:nursing / Q000592:standards; D017723:Drug Utilization Review; D004739:England; D006801:Humans; D008370:Manuals as Topic / Q000592:standards*; D008508:Medication Errors / Q000451:nursing / Q000517:prevention & control / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000188:drug therapy / Q000451:nursing; D009730:Nursing Assessment; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D009737:Nursing Records / Q000592:standards; D009741:Nursing Staff, Hospital / Q000193:education / Q000458:organization & administration / Q000523:psychology; D010353:Patient Education as Topic / Q000592:standards; D019338:Polypharmacy; D011568:Psychiatric Nursing / Q000193:education / Q000458:organization & administration*; D011619:Psychotropic Drugs / Q000008:administration & dosage* / Q000009:adverse effects; D018709:Statistics, Nonparametric; D017749:Total Quality Management / Q000458:organization & administration
chemical_list: D011619:Psychotropic Drugs