Stokes Julie A, Purdie David M, Roberts Michael S
Therapeutics Research Unit, School of Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, Queensland 4102, Australia.
Pharm World Sci. 2004 Jun;26(3):148-54. doi: 10.1023/b:phar.0000026803.89436.a8.
To identify determinants of PRN (as needed) drug use in nursing homes. Decisions about the use of these medications are made expressly by nursing home staff when general medical practitioners (GPs) prescribe medications for PRN use.
Cross-sectional drug use data were collected during a 7-day window from 13 Australian nursing homes. Information was collected on the size, staffing-mix, number of visiting GPs, number of medication rounds, and mortality rates in each nursing home. Resident specific measures collected included age, gender, length of stay, recent hospitalisation and care needs.
The number of PRN orders prescribed per resident and the number of PRN doses given per week averaged over the number of PRN medications given at all in the seven-day period.
Approximately 35% of medications were prescribed for PRN use. Higher PRN use was found for residents with the lower care needs, recent hospitalisation and more frequent doses of regularly scheduled medications. With increasing length of stay, PRN medication orders initially increased then declined but the number of doses given declined from admission. While some resident-specific characteristics did influence PRN drug use, the key determinant for PRN medication orders was the specific nursing home in which a resident lived. Resident age and gender were not determinants of PRN drug use.
The determinants of PRN drug use suggest that interventions to optimize PRN medications should target the care of individual residents, prescribing and the nursing home processes and policies that govern PRN drug use.
确定养老院按需（PRN）用药的决定因素。当全科医生（GPs）开具PRN用药处方时，养老院工作人员会明确做出这些药物使用的决定。
在7天时间内收集了来自13家澳大利亚养老院的横断面用药数据。收集了每家养老院的规模、人员配置、来访全科医生数量、给药轮次和死亡率等信息。收集的居民特定指标包括年龄、性别、住院时间、近期住院情况和护理需求。
每位居民开具的PRN医嘱数量以及在7天期间内所有PRN药物给药总数的基础上平均每周给予的PRN剂量数。
约35%的药物是开具为PRN使用的。护理需求较低、近期住院以及定期用药剂量更频繁的居民PRN用药量更高。随着住院时间的增加，PRN用药医嘱最初增加然后下降，但给药剂量从入院时就开始下降。虽然一些居民特定特征确实会影响PRN药物使用，但PRN用药医嘱的关键决定因素是居民所在的特定养老院。居民年龄和性别不是PRN药物使用的决定因素。
PRN药物使用的决定因素表明，优化PRN药物的干预措施应针对个体居民的护理、处方以及管理PRN药物使用的养老院流程和政策。
