What Is the Purpose of a Prn Protocol Document

NCCR is the acronym for “pro re nata”, written for recipes whose administration should be based on the needs of patients and not at fixed times. The objective of this systematic review was to investigate safety issues and adverse events arising from the prescription and administration of NCRs. Electronic databases such as Scopus, PubMed [including Medline], Embase, Cinahl, Web of Science and ProQuest were systematically searched for articles published between 2005 and 2017. Selection criteria: We included all randomised controlled trials (RCTs) and studies with comparison groups and compared prescribing and administration of PRN with planned administration where safety issues and adverse events were reported. The authors independently assessed the titles, abstracts and full texts of the retrieved studies on the basis of inclusion criteria and risk of bias. The results were summarized narratively. The search resulted in 7699 products. Title, abstract and full-text evaluations resulted in 5 articles. The included studies were RCTs with one exception, a post-test pre-test experimental design. Patient populations, interventions and outcomes varied. Studies compared patient-controlled or routine administration with PRN and one study examined the effect of a practice guideline on the implementation of NCCR administration. More analgesia was administered in the patient-controlled arms than in the PRN arms, but the reduction in pain was similar. However, there was little difference in the administration of psychotropic drugs.

No differences were reported between patient-controlled and NCCR groups for adverse events. The NCCR practice policy has improved the education of NCCR patients, but the non-documentation of NCCR administration has increased. This systematic review suggests that NCCR safety issues and adverse events are a poorly studied area of health practice. Differences in interventions, outcomes and clinical domains make it difficult to assess the overall quality of the evidence. Well-designed RCTs are needed to identify safety issues and adverse events associated with the administration of NCRs. Baker et al. [15] studied the influence of a textbook on the prescribing and administration of psychotropic medications. For 10 weeks, patients received 484 doses of PRN psychotropic drugs.

Three patients received more than 50 doses and 7 patients did not receive PRN drugs. The types of drugs changed significantly over the course of the study: benzodiazepines and antipsychotics were reduced, but Z drugs (zopiclone) increased. Many drugs were administered alone, but 12 different combinations of drugs were used, mainly haloperidol and lorazepam. 36.5% of the maximum prescribed doses of antipsychotics for PRN met or exceeded the British National Formulary guidelines. The quality of care notes decreased and the non-documentation of prN administration increased after the introduction of the manual. There was no documented evidence of monitoring for side effects for a dose of PRN administered in both arms during the study. The average quality of prescriptions, which was assessed using separate eight-level quality rating scales, increased but was not statistically significant. Patient information and training recorded on the forms provided increased significantly after manual introduction. The staff found the manual well organized, helpful and understandable.

Unplanned drugs fall into the “Stat” and “NCCR” categories. Statistical drugs usually refer to the prescription and administration of a single dose in addition to the routine or regular prescription of drugs. PRN drugs are prescribed in advance, if necessary after clinical evaluation or on written or oral instruction [12,14]. The prescribing and administration of NCCr creates an exceptional circumstance for patient care that allows for frequent or intermittent use of drugs without direct medical supervision [7], usually with analgesics, laxatives, sedatives, antiemetics, antipsychotics, anxiolytics, and hypnotics [8,9,15]. PrN increases nurses` participation in decision-making and patient care by allowing nurses to administer medications on time without having to call others to write new prescriptions [16]. The reasons for the use of PRN prescriptions should be continuously monitored to avoid errors of practice such as excessive doses, overuse and polypharmacy and to ensure the effectiveness of management plans [17]. During the prescribing and administration of NCRs, health care providers should document possible adverse drug reactions (ADRs) in a separate document in the patient`s medical record and share it with prescribing physicians and pharmacists [18, 19]. The fluctuation is given in Table 3.

Incomplete data documentation may have resulted in a high risk of wear distortion in the studies by Baker et al. [15] and Hajimaghsoudi et al. [31]. All studies followed their protocols and reported their results accordingly. Baker et al. [15] reported medication errors in 23 out of 35 patients, with the exception of low-quality prescriptions. Errors included: failure to discontinue PRN when a regular dose was prescribed – one patient received a daily dose of 30 mg of olanzapine; the same medication prescribed twice as the NCCR; The omission of prescriptions, which led to the administration of the same drug from two identical prescriptions – one patient regularly received two different antipsychotics and received two others in NCCR. Administration errors included: administration of doses other than those prescribed (usually lower), inconsistent documentation, inconsistencies between treatment protocol and care instructions. Medication records must be created in accordance with an organization-specific protocol. In some cases, pharmacies may create drug delivery records for facilities that administer an abundant amount of routine and/or NCCR medications. Morad et al. [30] reported no differences between the PCA and NCCR groups in terms of sedation, coma, respiratory rate, systolic blood pressure, heart rate, nausea, vomiting, oxygen saturation or neurological deterioration.

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