Harper Lori, Reddon John R, Hunt Courtney J, Royan Heather
a Villa Caritas Hospital , Edmonton , Alberta , Canada.
b University of Alberta , Edmonton , Alberta , Canada.
Clin Gerontol. 2017 Oct-Dec;40(5):392-400. doi: 10.1080/07317115.2017.1311287. Epub 2017 Mar 24.
To improve patient care/outcome, an evaluation was conducted of nursing procedures and protocols for pro re nata (PRN) medications.
A 14-day chart review was conducted for 27 patients with mood and thought disorders (MTD) and for 24 patients with organic disorders (OD) at a geriatric psychiatric hospital, and a questionnaire was completed by 20 nurses.
377 PRNs were administered to patients in the MTD and OD units (240 and 137, respectively). The majority of PRNs were administered during the evening shifts on the MTD unit and during the day shifts on the OD unit. Chart notes indicated the behavior requiring PRN administration was not always specifically described and therapeutic interventions were not often attempted before PRN administration. Inconsistency between chart notes and medication record books was noted in the majority of cases. It was often not known whether the PRN was initiated by the staff, patient, or family. PRNs were reported to be not effective in the majority of cases.
Documentation was suboptimal and effectiveness was poor.
It would be worthwhile to train all staff in a patient-centered or ecopsychosocial (i.e., non-pharmacological) model of care, which would provide staff alternatives to PRNs. In that context, it would be important to implement standards of practice into geriatric psychiatry inpatient settings for PRN administration and documentation.
为改善患者护理/治疗效果，对按需（PRN）用药的护理程序和规范进行了评估。
对一家老年精神病医院的27名患有情绪和思维障碍（MTD）的患者以及24名患有器质性障碍（OD）的患者进行了为期14天的病历审查，并由20名护士完成了一份问卷调查。
MTD和OD科室的患者共接受了377次按需用药（分别为240次和137次）。大多数按需用药是在MTD科室的晚班期间以及OD科室的白班期间进行的。病历记录显示，需要按需用药的行为并非总是有具体描述，并且在按需用药前并不经常尝试进行治疗干预。在大多数情况下，病历记录与用药记录簿之间存在不一致。通常不清楚按需用药是由工作人员、患者还是家属发起的。据报告，大多数情况下按需用药并不有效。
记录不充分，效果不佳。
对所有工作人员进行以患者为中心或生态心理社会（即非药物）护理模式的培训是值得的，这将为工作人员提供按需用药的替代方法。在这种情况下，在老年精神病住院环境中实施按需用药和记录的实践标准非常重要。
