PRN medication: protocols, administration and follow-up

Give an as-needed medicine within its protocol, record why, and follow up whether it worked.

Before you begin

• The PRN is charted with its reason and limits.
• You hold a current medication competency.

Give a PRN in the app

1. Open Medication from your shift. Scroll to PRN (as needed).
2. Tap Give next to the medicine. The Give PRN sheet shows how many doses were given in the last 24 hours, or Limit reached in red.
3. Type the Reason for giving now (what you saw and why).
4. For a high-risk PRN, tick Less restrictive strategies were tried first if it applies and complete the second check.
5. Leave Remind me to check the effect on, then tap Record PRN given.

Give a PRN on the web

1. Go to Care → Medication and eMAR and select Give a PRN. Choose the medicine (filter by Participant). A Chemical restraint badge marks PRNs on the restrictive practice register.
2. The panel shows PRN reason on chart and Maximum in 24 h, then an interval check: green when it is fine, red for Daily maximum reached or Minimum interval not met.
3. Write the Reason for giving (more than 3 characters), tick the five rights, and for a chemical restraint tick Less restrictive strategies from the behaviour support plan were tried first.
4. Select Record PRN. The message says when the effect follow-up is due.

Record the effect

1. Open the PRN register tab. It lists PRN doses from the last 7 days with the reason, worker and Effect.
2. Select Record effect on a dose. Choose Effective, Partly or Not effective, write What you observed, and select Save effect.
3. If not effective, tell the RN on call so they can review. Filter Effect by Not yet recorded to find follow-ups due.

Watch PRN use

1. PRN effect follow-ups due at the top counts doses with no effect recorded; unrecorded effects also raise a PRN effect not recorded exception.
2. The Medication round tab shows Frequent PRN use (7 days) for anyone given 3 or more PRN doses, as a prompt to review triggers with the prescriber and behaviour support practitioner.

Tips

• The effect check is due 30 minutes after the dose by default, or at the time set on the medicine.

If something goes wrong

“The most this PRN can be given is N times in 24 hours.” or “Wait at least N minutes between doses of this PRN.”

The limit on the chart has been reached. Don’t give it; contact the RN on call. A nurse with override permission can authorise a dose over the limit.

“This PRN needs authority from the nurse or on-call before it’s given.”

The medicine is charted as needing authority. Call the nurse or on-call first.

“Confirm that the less restrictive strategies in the behaviour support plan were tried first.”

Tick the box only if they were. If not, try them before giving the PRN.

Record PRN stays greyed out.

Write a reason and tick the five rights. It also stays off while the limit or interval check is red.