Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; Pharmacy Department, Monash Health, Melbourne, Australia.
J Am Med Dir Assoc. 2021 Jan;22(1):117-123.e1. doi: 10.1016/j.jamda.2020.04.033. Epub 2020 Jun 29.
To investigate administration of pro re nata (PRN) medications and nurse-initiated medications (NIMs) in Australian aged care services over a 12-month period.
Twelve-month longitudinal audit of medication administrations.
Three hundred ninety-two residents of 10 aged care services in regional Victoria, Australia.
Records of PRN and NIM administration were extracted from electronic and hard copy medication charts. Descriptive statistics were used to calculate medication administration per person-month. Poisson regression was used to estimate predictors of PRN administration.
Over a median follow-up of 12 months (interquartile range 10-12 months), 93% of residents were administered a PRN medication and 41% of residents an NIM on 21,147 and 552 occasions, respectively. The mean number of any PRN administration was 5.85 per person-month. The most frequently administered PRN medications per person-month were opioids 1.54, laxatives 0.96, benzodiazepines 0.72, antipsychotics 0.48, paracetamol 0.46, and topical preparations 0.42. Three-quarters of residents prescribed a PRN opioid or PRN benzodiazepine and two-thirds of residents prescribed a PRN antipsychotic had the medication administered on 1 or more occasions over the follow-up.
Most residents were administered PRN medications. Administration was in line with Australian regulations and institutional protocols. However, the high frequency of PRN analgesic, laxative, and psychotropic medication administration highlights the need for regular clinical review to ensure ongoing safe and appropriate use.
在 12 个月的时间里，调查澳大利亚老年护理服务中按需（PRN）给药和护士发起的给药（NIM）的管理情况。
对给药进行为期 12 个月的纵向审计。
澳大利亚维多利亚州地区 10 家老年护理服务的 392 名居民。
从电子和纸质用药图表中提取 PRN 和 NIM 给药记录。使用描述性统计计算每人每月的给药量。使用泊松回归估计 PRN 给药的预测因素。
在中位数为 12 个月（四分位间距 10-12 个月）的随访中，93%的居民接受了 PRN 药物治疗，41%的居民接受了 NIM 治疗，分别有 21147 次和 552 次。任何 PRN 给药的平均次数为每人每月 5.85 次。每人每月最常给予的 PRN 药物分别为阿片类药物 1.54 次、泻药 0.96 次、苯二氮䓬类药物 0.72 次、抗精神病药 0.48 次、对乙酰氨基酚 0.46 次和局部制剂 0.42 次。四分之三接受 PRN 阿片类药物或 PRN 苯二氮䓬类药物治疗的居民和三分之二接受 PRN 抗精神病药物治疗的居民在随访期间至少有 1 次接受了该药物治疗。
大多数居民接受了 PRN 药物治疗。给药符合澳大利亚法规和机构方案。然而，PRN 镇痛药、泻药和精神药物的高频率给药突出表明需要定期进行临床审查，以确保持续安全和适当的使用。
