‘As required’ or ‘Pro re nata’ (PRN) medications are probably the most widely used intervention in mental health wards (Baker et al, 2008a). Most service users will receive extra medication during an inpatient admission. These are most likely to be given in the early days of an admission, although there is a sub-group who will have lots of extra medication throughout their admission, and it is most likely that the drugs given will be Lorazepam (a benzodiazepine), Haloperidol or Olanzapine (antipsychotics), or sleeping tablets (e.g. Zopiclone).
For some service users, access to PRN medication is a helpful way to manage distress or feelings of agitation, and of all coercive interventions used on wards PRN is one if the least restrictive, and has higher approval rating by service users. However, it is not without its problems. There is widespread concern that PRN can be abused by staff and service users (Baker et al, 2008a), and its long term use (particularly of benzodiazepines) can lead to dependency. Given the widespread use of PRN medications (millions of doses are administered every year) having a robust understanding of which drugs work best for whom is key.
A recently updated Cochrane review (Douglas-Hall et al, 2016) aimed to identify studies that compared PRN regimes with regular treatment in the management of either primary outcomes of psychotic symptoms or behavioural disturbances. Secondary outcomes included behaviour, dose of medication used, adverse events, satisfaction with care, leaving the study early, hospital outcomes and cost of care.