Staff perceptions of PRN medication in a residential care setting
| Date | 24 October 2019 |
| Published date | 24 October 2019 |
| DOI | https://doi.org/10.1108/JMHTEP-10-2018-0059 |
| Pages | 469-479 |
| Author | Daniel Robert Stubbings,Kyle Hughes,Caroline Limbert |
| Subject Matter | Health & social care |
Staff perceptions of PRN medication in a
residential care setting
Daniel Robert Stubbings, Kyle Hughes and Caroline Limbert
Abstract
Purpose –The purpose of this paper is to explore the perceptions of staff towards psychotropic Pro Re Nata
(PRN) medication in a residential care setting.
Design/methodology/approach –Three male and seven female participants were interviewed using a
semi-structured interview. Transcripts were analysed using thematic analysis.
Findings –Four themes pertaining to PRN medication emerged from the data: behaviour change, calming
effect, importance of timing and perceived uniqueness.
Research limitations/implications –The participant group was not homogenous and findings may have
been different in a more qualified cohort. This care setting may not be representative of other environments
where PRN medication is administered. The findings do, however, highlight some of the challenges facing the
administration of PRN medication in mental health and care settings.
Practical implications –The awareness of these themes is significant for improving staff knowledge,
training practices and policies towards the use and administration of psychotropic PRN medication.
Originality/value –This is the first study to engage in a thematic analysis of staff views towards the
administration of PRN medication.
Keywords Mental health, Thematic analysis, Staff perceptions, Psychotropic medication, Residential care
Paper type Research paper
When medication is administered “as needed”or “when required”it is referred to as PRN, which
is the acronym for the Latin phrase Pro Re Nata. PRN psychotropic medication is administered in
a variety of mental health settings (Wicher et al., 2002) and should be done so in collaboration
with the service user (Matthias et al., 2012). However, the decision to use PRN is a subjective one
based on the clinical views of the staff, the views and behaviour of the patient, the organisational
policies and the legislation of the country. The National Institute for Health and Care Excellence
(NICE, 2014), the Royal Pharmaceutical Society of Great Britain (Royal Pharmaceutical Society,
2007) and the Nursing and Midwifery Council’s guidelines on medicines management all fall short
of providing evidence-based guidance on how staff should make judgements about when
psychotropic PRN medication is “needed”.
Psychotropic medication is one of the most frequently used (Akram et al., 2014; Ziguras et al., 1999)
forms of treatment in mental healthcare settings. Due to an increasing population and long-term
usage, the financial costs have also been increasing (Ilyas and Moncrief, 2012). It is a group of
medications that affects mood, mental status, perceptions and/or physiological arousal (Kalachnik
et al., 1995). It is estimated that approximately 70–90 per cent of residents within inpatient mental
health settings receive this form of medication (Baker et al., 2007). Negative consequences of
psychotropic medication can include prolonged institutionalisation (Centorrino et al., 2004; John
et al., 2014) and increased mortality (Johnell et al., 2016; Waddington et al., 1998). Polypharmacy is
not considered the best medical practice (Kreyenbuhl et al., 2007), yet PRN is typically administered
to service users who are already on an array of other psychotropic medication (Thapa et al., 2003).
Variations in administration practices between healthcare settings highlight potential concerns
regarding PRN medication. Some treatment settings experience an increase in medication around
the time of staff shift changes and institutions that are more restrictive use more medication (Curtis
and Capp, 2003; Vander Stichele et al., 2006). These patterns suggest that PRN medication might
Received 19 October 2018
Revised 31 December 2018
Accepted 7 August 2019
Daniel Robert Stubbings,
Kyle Hughes and
Caroline Limbert are all based
at the Department of Applied
Psychology, School of Health
Sciences, Cardiff Metropolitan
University, Cardiff, UK.
DOI 10.1108/JMHTEP-10-2018-0059 VOL. 14 NO. 6 2019, pp. 469-479, © Emerald Publishing Limited, ISSN 1755-6228
j
THE JOURNAL OF MENTALHEALTH TRAINING, EDUCATION AND PRACTICE
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