Stein-Parbury Jane, Reid Kim, Smith Narelle, Mouhanna Diane, Lamont Fiona
South Eastern Sydney Illawarra Area Health Service, Kogarah, NSW, Australia.
Aust N Z J Psychiatry. 2008 Apr;42(4):283-92. doi: 10.1080/00048670701881553.
Available evidence suggests that the use of 'as needed' (PRN; from the Latin pro re nata: for an occasion that has arisen) medications has remained a standard aspect of treatment in acute inpatient mental health units over a number of years despite lack of evidence from controlled clinical trials. The practice is one in which doctors and nurses are interdependent; that is, while doctors prescribe the medications, professional nurses are the ones who make the clinical decisions to administer them. The aim of the present study was to provide a detailed description of the circumstances surrounding the use of PRN medications across four inpatient units in Sydney.
The medical records of all patients admitted for >24h during a 2 month period were retrospectively audited for details regarding prescriptions and administrations of PRN medications.
A total of 420 records were reviewed, producing a total of 3868 PRN medication administrations. Ninety-seven per cent of all patients were prescribed PRN medications and 93.8% were prescribed regular medications. The most frequently prescribed medications were second-generation antipsychotics for regular use along with benzodiazepine for PRN use. Nearly 84% of patients received at least one PRN medication during their admission, while patients diagnosed with personality disorder received more PRNs per day. The most common reason for PRN administration was patient agitation. The results indicated poor documentation in the prescription and documentation of PRN administrations. Also, the findings show that a small subset of the patients (5%) received >30% of all PRN medications.
PRN medication use has endured as standard practice and the results of the present study are consistent with the reported frequency of use increasing slightly over the years. The combination of second-generation antipsychotics as regular medications and benzodiazepines for PRN medication is consistent with recommended treatment guidelines. The small subset of patients who were overrepresented in the PRN administrations is noteworthy.
现有证据表明，尽管缺乏对照临床试验的证据，但多年来，按需（PRN；源自拉丁语pro re nata，意为针对出现的情况）用药一直是急性住院精神科病房治疗的一个标准方面。这种做法中医生和护士相互依赖；也就是说，虽然医生开处方用药，但专业护士才是做出用药临床决策的人。本研究的目的是详细描述悉尼四个住院病房中按需用药的相关情况。
回顾性审核了2个月期间所有住院超过24小时患者的病历，以获取按需用药处方和用药的详细信息。
共审查了420份病历，产生了总计3868次按需用药记录。所有患者中有97%被开具了按需用药，93.8%被开具了常规用药。最常开具的常规用药是第二代抗精神病药物，按需用药是苯二氮䓬类药物。近84%的患者在住院期间至少接受过一次按需用药，而被诊断为人格障碍的患者每天接受的按需用药更多。按需用药最常见的原因是患者激动。结果表明，按需用药的处方和记录文件存在缺陷。此外，研究结果显示，一小部分患者（5%）接受了所有按需用药的30%以上。
按需用药一直是标准做法，本研究结果与多年来报道的使用频率略有增加一致。第二代抗精神病药物作为常规用药与苯二氮䓬类药物作为按需用药的组合符合推荐的治疗指南。在按需用药中占比过高的一小部分患者值得关注。
