title: Analysis of non-pharmacological interventions attempted prior to pro re nata medication use.
abstract: The aim of the present study was to elucidate what non-pharmacological interventions are applied by nursing staff prior to the administration of psychotropic pro re nata (PRN) medication. Best practices would instruct clinical staff to provide non-pharmacological strategies, such as de-escalation and skills coaching, as the first response to patient distress, anxiety, or agitation. Non-pharmacological strategies might be safer for patients, promote more collaborative relationships, and facilitate greater skills development for managing symptoms. The literature has highlighted that poor documentation of pre-PRN administration interventions has limited our understanding of this practice, but evidence suggests that when this information is available, non-pharmaceutical approaches are not being attempted in the majority of cases. This is troubling given that, while clinically appropriate in some instances, PRN have been subject to criticism and lack critical evidence to support their use. The current study is a continuation of our previous work, which examined the reason, frequency, documentation, and outcome (e.g. effectiveness, side-effects) of PRN medication use at our facility. A chart review was conducted to understand what happens prior to the administration of PRN medication at our facility across all inpatient units over the course of 3 months. Results support previous findings that non-pharmacological interventions are poorly documented by front-line staff and are seemingly used infrequently. The use of these interventions differs by patient presentation (e.g. agitation, insomnia), and most often include supportive measures. The findings suggest that both documentation and intervention practices of nursing staff require further investigation and adjustment to align with best practices.
authors.affiliation: Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada.
authors.forename: Krystle
authors.initials: K
authors.lastname: Martin
authors.affiliation: Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada.|Department of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Vinita
authors.initials: V
authors.lastname: Arora
authors.affiliation: Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada.|Department of Psychiatrity, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ilan
authors.initials: I
authors.lastname: Fischler
authors.affiliation: Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada.
authors.forename: Renee
authors.initials: R
authors.lastname: Tremblay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression / Q000187:drug effects / Q000523:psychology; D001007:Anxiety / Q000188:drug therapy / Q000628:therapy; D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy / Q000628:therapy*; D008875:Middle Aged; D011595:Psychomotor Agitation / Q000188:drug therapy / Q000628:therapy; D011618:Psychotic Disorders / Q000188:drug therapy / Q000628:therapy; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy / Q000628:therapy; D055815:Young Adult
chemical_list: D011619:Psychotropic Drugs
keywords: inpatient; intervention; medication; mental illness; pro re nata