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Human rights and rapid tranquillisation
Published in Bernadette McSherry, Yvette Maker, Restrictive Practices in Health Care and Disability Settings, 2020
Peter Bartlett, Stephanie Sampson
The discussion of implementation is complicated by ambiguities in the policies as to how far rapid tranquillisation is to be understood as a response to an immediate and quite possibly unanticipated event, how much part of a planned strategy of care and treatment and how rapid tranquillisation is distinguished from ongoing treatment. Certainly, the policies often make it clear that the objective of rapid tranquillisation is the control of behaviour, rather than the treatment of the underlying condition. However, as a number of the policies makes clear, ongoing medication is also prescribed for this purpose, and the medications prescribed – generally psychotropics – may well be the same in each context. These medications may be prescribed on a ‘PRN’ (pro re nata – as needed) basis as part of the treatment plan, and the use of these medications in that way is expressly viewed by a number of the policies as an appropriate part of a de-escalation strategy, as distinct from their use as rapid tranquillisation as defined by the policy. The policies appear to view this as part of general treatment rather than restraint.
Essential paperwork
Published in Sabina Dosani, Peter Cross, Making it in British Medicine, 2018
a section known as prn, pro re nata, which is Latin for as required. Patients or nurses use their own judgement for when these are taken. Specify the dose and a dose interval, such as ‘maximum frequency every four hours’. Consider prescribing certain drugs like analgesics and laxatives on the prn side routinely
Pain management
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Due to the fear of causing excessive sedation, opioids have historically been administered on an as-needed, pro re nata (PRN), basis. The theoretical advantage of nurse-delivered medication is that the patient’s neurologic examination can be assessed prior to the administration of each dose of analgesic. In the case of opioids, a nurse is able to assess whether a patient is awake enough to tolerate the prescribed dose. An alternative and very common analgesic regimen in non-neurosurgical patients is intravenous patient controlled analgesia (PCA). PCAs offer patients the ability to self-deliver analgesics, usually in the form of short-acting opioids, without enduring delays caused by variable nursing response times and in drug delivery. Patients must presumably be awake enough to sense pain and engage the PCA mechanism to trigger the delivery of the drug at each permissible interval. PCAs can also reduce workload burden on nursing staff by decreasing the number of calls from patient rooms. Finally, the process of opioid reconciliation is simpler for a single opioid PCA cartridge than for individual opioid doses that a nurse must hand deliver as needed. By handling multiple doses of opioids, nurses expose patients to a higher risk of cross-contamination, and they expose themselves, collectively, to a risk of opioid diversion. Unless patients have a history of opioid dependence, continuous infusions of opioids should be avoided in nonmechanically ventilated patients.
Reducing inappropriate polypharmacy for older patients at specialist outpatient clinics: a systematic review
Published in Current Medical Research and Opinion, 2023
Louise Clarkson, Laura Hart, Alfred K. Lam, Tien K. Khoo
The participants in the included studies had a high prevalence of polypharmacy (mean number of medications ranged from 4.6 to 23.2), multimorbidity, and use of PIMs. The studies were heterogenous with regards to how medication count was determined. Some studies incorporated “when required (pro re nata, PRN)” medications or self-prescribed (over-the-counter) medications. Pill burden (as assessed by a Living with Medicines Questionnaire) and tablet count was examined in one study36. The definition of polypharmacy was consistent between studies, with five or more medicines classified as polypharmacy. Two included studies involved participants with a mean number of medications of marginally less than 5 (4.6 and 4.7, respectively), which may have reduced the opportunity for deprescribing29,30. The mean number of medications for study participants varied between settings, with medication load being highest for individuals attending heart failure clinics and renal dialysis units35–39. A high medication burden was also found in patients with cancer aged ≥65 years.
Child and Adolescent Psychiatric Inpatient Care: Contemporary Practices and Introduction of the 5S Model
Published in Evidence-Based Practice in Child and Adolescent Mental Health, 2022
Casey D. Calhoun, Elizabeth A. Nick, Kyrill Gurtovenko, Aaron J. Vaughn, Shannon W. Simmons, Rebecca Taylor, Eileen Twohy, Jessica Flannery, Alysha D. Thompson
EFM involves use of medication as a form of chemical restraint when patients pose danger to themselves or others; this intervention has historically been used when patients do not respond to seclusion or restraint. In comparison, pro re nata (PRN) or “as needed” medication is typically non-emergent, consented to by patients beforehand, and administered in response to observable (usually predictable) changes in emotional or behavioral symptoms as a means of preventing further escalations. A review by Baker and Carlson (2018) notes that research has yet to demonstrate any potential benefits of using medication (PRN, EFM) to treat agitated outbursts in youth. Thus, decisions to utilize EFM and PRN medications should be used only when all other strategies have failed and strong safety concerns remain.
Patient Participation in Pro Re Nata Medication in Forensic Psychiatric Care: Interview Study with Patients and Nurses
Published in International Journal of Forensic Mental Health, 2021
The participation of patients in the prescription and administration of their pro re nata (PRN, as-needed) medication has been emphasized in psychiatric care (Baker et al., 2007). In addition to being an ethical right (Lindberg et al., 2019), involving patients in decisions on their medication can support their adherence to treatment (NICE, 2009; Torrecilla-Olavarrieta et al., 2020) and help them to learn how to safely and effectively use PRN, based on their individual medication needs, to improve their quality of life. However, forensic psychiatric patients are particularly vulnerable when it comes to participation due to their poor mental health status and the involuntary nature of treatment (Selvin et al., 2016, 2021). In addition, patient participation has been threatened by power imbalances between patients and staff (Hörberg & Dahlberg, 2015; Söderberg et al., 2020) and paternalistic treatment cultures (Haines et al., 2018; Selvin et al., 2016). Forensic inpatients have reported their willingness to participate (Selvin et al., 2016) and provide opinions on their care (Marklund et al., 2020). Nonetheless, patients’ participation has been found to be limited (Eidhammer et al., 2014; Haines et al., 2018; Söderberg et al., 2020), and patients have rated patient participation as the lowest-quality aspect of their care (Schröder et al., 2016).