As Required “PRN” Medication Guidance
Gloucestershire Shared Lives
Aim
This guidance aims to support and guide Shared Lives Carers in administering and recording the use of PRN medication for people who use Gloucestershire Shared Lives.
Context
The administration of PRN medication requires skill, competence and training. Before administering any medication Shared Lives Carers need to have completed Medication Administration Training and competency quiz and be deemed competent and confident in administering PRN medication. Several medications may be prescribed by a prescribing health care professional on an “as required” PRN basis. These medicines range from pain medications and inhalers to antipsychotics. PRN medication will require a PRN administration plan and a medication protocol to ensure that clear instructions are in place for how and when to administer PRN medications. Protocols will be put in place by the prescribing professional and followed by Shared Lives Carers. Protocols will require review on a 12 month basis (minimum).
STOMP
Where PRN medication is used for support with managing of behaviour, consideration needs to be given to STOMP which aims to ensure that medication is used appropriately. We all need to follow the principles laid out in STOMP:
STOMP stands for “stopping overmedication of people with a learning disability, autism or both”. Details of which are here:
https://www.england.nhs.uk/learning-disabilities/improving-health/stomp/
Recording
PRN medication should be recorded on MAR for PRN medication
The Gloucestershire Shared Lives Medication Policy states the following- 7.5 The carer will record the reason for administering an ‘as required’ / variable dose medication and the dose administered on the MAR sheet each time the medication is given.
Where PRN medication is required, Shared Lives Carers must check the maximum dose stated, when it was last given and that the correct time has elapsed between the last dose. Individuals should be offered the opportunity to utilise alternative coping mechanisms (i.e changing position, altered diet, altered environment, application of cold/heat) as an alternative to PRN medication where appropriate and as identified and agreed with health care professionals.
For medicines used to manage a person’s behaviour CQC state that staff should know how to support a person in a different way before using a medicine. For example, changes to the person’s environment
CQC state that when PRN medicines are administered the record should include:
- the reasons for giving the when required medicine
- how much has been given including if a variable dose has been prescribed
- the time of administration for time sensitive medicines
- the outcome and whether the medicine was effective
PRN protocols will often work alongside behaviour guidelines or plans e.g. PBS plan and fit in with the overall approach to supporting someone in relation to behaviours that challenge.
Handovers of PRN medication between different Shared Lives Carers and/or other services should be detailed on the back of the MAR sheet. For example, where PRN medication has been administered by another Shared Lives Carer/Family member/service a note on the back of the GSL MAR sheet should detail the handover that has been verbally provided including date, time and amount of medication administered. This is to reduce the risk of overdose and medication administration errors.
Reviewing of PRN medication
CQC state that we need to work with prescribers to ensure that PRN medicines are regularly reviewed. Thorough recordings, as outlined above, will support with and aid our involvement in this process and ensure that we are able to provide sufficient supportive evidence.
