title: Psychotropic PRN use among older people's inpatient mental health services.
abstract: Concerns have been expressed about the use of antipsychotics with older people, particularly in those who have dementia. Pro re nata (PRN) psychotropic medications including antipsychotics are commonly used to manage disturbed and distressed behaviour. This audit aimed to understand the use of PRN psychotropic medications in older people's inpatient mental health services and the quality of prescriptions and nursing documentation associated with this. A retrospective audit was undertaken on 154 patients on 11 wards in three Mental Health Trusts in the North West of England. A proforma adapted from previous research was used to collect data. Eighty-seven patients were prescribed combinations of 14 psychotropic drugs in 145 different prescriptions as PRN. Seventy-six doses of PRN were administered to 26 patients (range 1-17 doses). The most commonly administered drug was Lorazepam (n = 28, 36.8%). Drugs were most frequently administered during the night (n = 33, 43.4%). The majority of administrations of PRN were not documented (n = 45, 59.2%). PRN appeared to be used differently (smaller doses and less frequently) in this study compared to previous research of those aged under 65. Further work needs to examine the use of the use of PRN psychotropic medicines and the older person, and focus on developing alternative nonpharmacological interventions.
authors.affiliation: PSSRU, University of Manchester, Oxford Road, Manchester M13 9PL, UK. John.A.Baker@manchester.ac.uk
authors.forename: J A
authors.initials: JA
authors.lastname: Baker
authors.forename: J
authors.initials: J
authors.lastname: Keady
authors.forename: P
authors.initials: P
authors.lastname: Hardman
authors.forename: J
authors.initials: J
authors.lastname: Kay
authors.forename: L
authors.initials: L
authors.lastname: Jones
authors.forename: D
authors.initials: D
authors.lastname: Jolley
mesh_terms: D000368:Aged / Q000706:statistics & numerical data*; D000374:Aggression / Q000187:drug effects; D004282:Documentation / Q000706:statistics & numerical data; D004334:Drug Administration Schedule; D011307:Drug Prescriptions / Q000451:nursing / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data; D004739:England; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008485:Medical Audit; D008605:Mental Health Services / Q000458:organization & administration; D009551:Night Care / Q000706:statistics & numerical data; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D009737:Nursing Records / Q000706:statistics & numerical data; D018579:Patient Selection; D019338:Polypharmacy; D011595:Psychomotor Agitation / Q000188:drug therapy; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy; D013222:State Medicine / Q000706:statistics & numerical data
chemical_list: D011619:Psychotropic Drugs