Promoting alternatives to PRN medicines in secure inpatient mental health services
Evidence and practice    

Promoting alternatives to PRN medicines in secure inpatient mental health services

Tim McDougall Director of nursing and quality, Lancashire & South Cumbria NHS Foundation Trust, Bury, England
Jaclyn Pickup Senior mental health practitioner, Greater Manchester Mental Health NHS Foundation Trust, England
Stephen Clarke Interim head of operations (forensic), Greater Manchester Mental Health NHS Foundation Trust, Manchester, England
John Baker Chair of mental health nursing, School of Healthcare, University of Leeds, and non-executive director, Leeds & York NHS Partnership Foundation Trust, Leeds, England
Samantha Alderson Quality surveillance analyst, Nursing and Governance, Greater Manchester Mental Health NHS Foundation Trust, England

Why you should read this article
  • To recognise the disadvantages of using ‘pro re nata’ (PRN) or ‘as required’ medicines in mental health services

  • To learn about a quality improvement project that was designed to explore alternatives to PRN psychotropic medicines

  • To consider various non-pharmacological interventions that could be used in your area of practice as an alternative to PRN medicines

The use of ‘pro re nata’ (PRN) or ‘as required’ medicines is widespread in inpatient mental health services, often as a first-line intervention when patients are experiencing challenging or strong emotions, despite recommendations that non-pharmacological interventions should be attempted first. Research suggests there is little evidence to support the use of PRN medicine regimens and practice appears to be based on clinical experience and habit rather than evidence.

This article describes a quality improvement project – known as the ‘Pause, Reflect, Next steps’ campaign – which was designed to explore alternatives to PRN psychotropic medicines for patients on low and medium secure mental health wards. The article explains how information about commonly used medicines, non-pharmacological alternatives to medicines and a visual map to guide mental health nurses’ and patients’ decision-making assisted in reducing PRN medicines use on participating wards. This reduction correlated with an increase in the use of non-pharmacological methods to support patients experiencing mental health issues.

Mental Health Practice. doi: 10.7748/mhp.2021.e1589

Peer review

This article has been subject to external double-blind peer review and checked for plagiarism using automated software

Correspondence

tim.mcdougall@lscft.nhs.uk

Conflict of interest

None declared

McDougall T, Pickup J, Clarke S et al (2021) Promoting alternatives to PRN medicines in secure inpatient mental health services. Mental Health Practice. doi: 10.7748/mhp.2021.e1589

Published online: 23 November 2021

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