Guidelines for the prescribing and administration of prn psychotropic medication
Guidelines for the prescribing and administration of PRN psychotropic medication
Document Control Summary Title
administration of PRN psychotropic medication.
Version Control Summary Version Comments / Changes Guidelines For The Prescribing and Administration of PRN (Pro Re Nata) Psychotropic Medication
The use of PRN psychotropic medication, such as haloperidol and lorazepam, during
All Trust inpatient charts have the facility to prescribe these drugs for rapid
tranquillisation PRN. Nursing staff are then able to administer these drugs to patients
PRN prescribing is clearly a valuable facility, particularly in those with acute,
fluctuating conditions. Nonetheless, it is open to misuse and PRN prescribing may
be unnecessary or inappropriate. PRN prescribing undoubtedly increases the risk of
patients being given above maximum doses. Indeed, findings from the recent POM
UK audit of high dose and combination antipsychotics prescribing (2006) confirm that
the prescribing of PRN antipsychotics is an apparent major contributor to combined
and high dose antipsychotic medication. Hence, the routine and common practice of
prescribing PRN antipsychotic medication needs to be addressed.
These guidelines should be read in conjunction with the Trust's High-dose
Antipsychotic and Rapid Tranquillisation Guidelines. (ELCMHT intranet / Policies
Aim of guidelines
The aim of these guidelines is to help change the culture of prescribing PRN
antipsychotic medication. That is, to discourage routine prescribing, to ensure safe,
effective and appropriate prescribing and to encourage regular review of PRN
Recommendation For Prescribing PRN Psychotropics: Choice of Drug
• Where sedation or tranquillisation is required, benzodiazepines, such as
lorazepam are preferred, at least initially. Promethazine may also be used.
In most patients, antipsychotics should be used second line.
• For agitation, if the intention is to improve the symptoms of a psychosis,
then the evidence is strong that antipsychotic medication is beneficial for
reducing agitation in both schizophrenia-like psychoses and in mania.
Additional medication with benzodiazepines can be used to augment the
effect of the antipsychotic in reducing agitation.
• When prescribing or administering "prn" antipsychotics one should
consider antipsychotics prescribed regularly and take the percentage
maximum dose of regular and PRN antipsychotics into account
Avoid Routine Prescribing of PRN
• In general, all PRN prescriptions should be individualised in the same way
that regular prescriptions are written for individual patients. PRN
medication should not routinely be prescribed in advance. If it is prescribed
in advance then the rationale for doing so should be clearly documented in
• Should nursing staff assess a patient to be in need of PRN psychotropic
medication, a doctor, who is available 24 hours a day, should first assess
the patients mental state and then prescribe PRN medication accordingly.
Specifics of the Prescription
• All PRN prescriptions should specify dose (not a range of doses),
frequency, maximum daily dose and the precise circumstances for which
the drug is to be given. A time period for the prescription must also be
• Medicines for rapid tranquillisation must be prescribed in the Rapid
Tranquillisation section of the prescription chart.
Review of PRN Medication
• All PRN prescriptions should be reviewed at least once a week by the
multidisciplinary team and if the drug is no longer required the prescription
• Should there be a need for the repeated administration of PRN
psychotropics, consider prescribing them regularly and discontinuing the
Documentation of Administered PRN Medication
• All PRN medication administered should be documented in the clinical
notes with details of the name of drug administered, date and time
administered, name and dose of drug, the specific symptoms and
conditions which resulted in the drug being administered and a description
of the patients response to the medication.
• All actions and interventions taken to prevent PRN psychotropics being
administered should also be documented in the clinical notes.
• After the event the patient should be offered the opportunity to write an
account of their experience of receiving PRN medication and this should be
kept in the medical notes. (NICE guidance for schizophrenia, 2006).
• The reason for administering the drug should also be documented in the
appropriate section of the prescription chart.
• Those patients who require night sedation should be prescribed and
administered licensed hypnotics rather than antipsychotics or short-acting
• When treating people with a diagnosis of depressive illness, mania or
paranoid psychosis (including schizophrenia) it is preferable to use a
sedative antidepressant or antipsychotic, rather than to use a
benzodiazepine or similar sedative-hypnotic. This is because
benzodiazepines do not improve depression or psychosis and may lead
• If a hypnotic is prescribed it should not be continued for longer than four
weeks (preferably one week) according to BNF recommendations. When
using a non-sedative antidepressant a benzodiazepine may be used briefly
to avoid the initial increase in agitation.
Medicines Committee March 2007
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