title: Pro re nata prescribing in a population receiving palliative care: a prospective consecutive case note review.
abstract: OBJECTIVE
  To document pro re nata (PRN) prescribing practices and to identify patterns with respect to clinical characteristics and the medications prescribed.
  
  
  METHODS
  Prospective consecutive case note review.
  
  
  METHODS
  Two interrelated consultative hospice and palliative care services in regional Victoria, Australia.
  
  
  METHODS
  Terminally ill inpatients and community-based individuals (N = 203) at the time of referral to a hospice or palliative care service.
  
  
  METHODS
  Number of medications that the referring physician prescribed on a PRN basis and on a regular basis for symptom control; comorbid disease, performance status, comorbidity burden, disease phase, and survival.
  
  
  RESULTS
  Mean number of PRN medications prescribed was 3.0, with significantly higher rates in the last week of life (rate ratio (RR) = 1.30, 95% confidence interval (CI) = 1.07-1.59) and during the terminal phase of disease (RR = 1.36, 95% CI = 1.09-1.68). One-quarter of prescriptions were for medications that met the Beers consensus criteria for potentially inappropriate medication use in elderly persons.
  
  
  CONCLUSIONS
  These descriptive baseline data are new. A mean of three different medications allows responsiveness to a variety of fluctuating symptoms, but there was a large range within the sample, indicating that some individuals and their caregivers have a high burden of administration-related decision-making.
authors.affiliation: Centre for Palliative Care, St Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: Bethany J
authors.initials: BJ
authors.lastname: Russell
authors.forename: Debra
authors.initials: D
authors.lastname: Rowett
authors.forename: David C
authors.initials: DC
authors.lastname: Currow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000932:Antiemetics / Q000627:therapeutic use; D001315:Australia; D001569:Benzodiazepines / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D017051:Hospice Care; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D019452:Terminally Ill
chemical_list: D000701:Analgesics, Opioid; D000932:Antiemetics; D001569:Benzodiazepines
keywords: hospice care; palliative care; physician prescribing patterns; polypharmacy; pro re nata