Mardani Abbas, Paal Piret, Weck Christiane, Jamshed Shazia, Vaismoradi Mojtaba
Nursing Care Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria.
Front Pharmacol. 2022 Apr 12;13:759998. doi: 10.3389/fphar.2022.759998. eCollection 2022.
Highly widespread use of (PRN) medicines in various healthcare settings is a potential area for improper medication prescription and administration leading to patient harm. This study aimed to summarize and integrate the findings of all relevant individual studies regarding the practical considerations of PRN medicines management including strategies and interventions by healthcare professionals for safe prescription, dispensing, administration, monitoring, and deprescription of PRN medicines in healthcare settings. An integrative systematic review on international databases were performed. Electronic databases including Web of Knowledge, Scopus, PubMed (including MEDLINE), and Cinahl were searched to retrieve articles published until end of May 2021. Original qualitative, quantitative, and mixed methods studies written in English were included with a focus on PRN medicines management in healthcare settings. Research synthesis using the narrative method was performed to summarise the results of included studies. Thirty-one studies on PRN medicines in healthcare settings by different healthcare providers were included after the screening of the databases based on eligibility criteria. They were published from 1987 to 2021. The majority of studies were from Australia, the United States, Canada, and the United Kingdom and were conducted in psychiatric settings. Given variations in their purposes, methods, and outcomes, the research synthesis was conducted narratively based on diversities and similarities in findings. Eight categories were developed by the authors as follows: "PRN indications and precautionary measures," "requirements of PRN prescription," "interventions for PRN administration," "monitoring and follow up interventions," "deprescription strategies," "healthcare professionals' role," "participation of patients and families," and "multidisciplinary collaboration." Each category consists of several items and describes what factors should be considered by healthcare professionals for PRN medicines management. The review findings provide insights on the practical considerations of PRN medicines management in clinical practice. The suggested list of considerations in our review can be used by healthcare professionals for optimal PRN medicines management and safeguarding patient care.
在各种医疗环境中，按需（PRN）用药的广泛使用是不当用药处方和给药的一个潜在领域，可能导致患者受到伤害。本研究旨在总结和整合所有相关个体研究的结果，这些研究涉及按需用药管理的实际考量，包括医疗保健专业人员在医疗环境中进行按需用药安全处方、调配、给药、监测和停用的策略及干预措施。我们对国际数据库进行了一项整合性系统评价。检索了包括Web of Knowledge、Scopus、PubMed（包括MEDLINE）和Cinahl在内的电子数据库，以获取截至2021年5月底发表的文章。纳入了以英文撰写的原创定性、定量和混合方法研究，重点是医疗环境中的按需用药管理。采用叙述法进行研究综合，以总结纳入研究的结果。根据纳入标准对数据库进行筛选后，纳入了31项不同医疗保健提供者关于医疗环境中按需用药的研究。这些研究发表于1987年至2021年。大多数研究来自澳大利亚、美国、加拿大和英国，且是在精神科环境中进行的。鉴于研究目的、方法和结果存在差异，基于研究结果的异同进行了叙述性研究综合。作者们确定了八类如下内容：“按需用药适应症和预防措施”、“按需用药处方要求”、“按需用药给药干预措施”、“监测和随访干预措施”、“停用策略”、“医疗保健专业人员的作用”、“患者及家属的参与”以及“多学科协作”。每一类都包含若干项目，描述了医疗保健专业人员在按需用药管理中应考虑的因素。该综述结果为临床实践中按需用药管理的实际考量提供了见解。我们综述中建议的考量清单可供医疗保健专业人员用于优化按需用药管理并保障患者护理。
