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.