PRN Medication and Over-The-Counter Medication
PRN is an abbreviation for the Latin pro re nata meaning “when needed”or as more commonly stated, “as needed”. It is used when a medication is to be given only under certain circumstances rather than on a regular schedule. The ability to use PRN medications often means timely treatment for our consumers. However, each medication requires a written protocol with clear guidelines regarding the use of that medication. The guidelines need to specify criteria such as a symptom, i.e. headache, temperature over 100 degrees F, etc. The Developmental Disabilities Program’s policy on PRN medication varies.
OVER THE COUNTER PRN MEDICATIONS
Over-the-counter (OTC) medications are those that can be purchased without a prescription from a doctor. These include such things as vitamins, ibuprofen, aspirin, antihistamines, etc. as well as herbal remedies and other homeopathic products.
All OTC medications for individuals in Developmental Disabilities services must have a physician’s written order or approval for their use as well as guardian consent if applicable, except in the event of an emergency. These medications must be reviewed and approved by the physician on an annual basis.
It is necessary to have an order for OTC products because:
đź’ŠIt is illegal to use OTC (over the counter) products without a physician’s order for anyone but yourself or a dependent.
đź’ŠThere may be harmful interactions between OTC medications and any prescribed medications being taken by an individual.
đź’ŠPrimary care physicians are usually aware of any allergies or other health concerns of the individual which would rule out the use of certain OTC products.
Each OTC medication must have a protocol for its use. This protocol should include specific directions for use as well as contain the following:
The name of the individual receiving the medication.
The name of the PRN medication including both generic and trade names to avoid confusion.
Under what conditions the medication is used such as physical or behavioral indicators. For example, an antihistamine may be used for an allergy if the person has a runny nose, itchy eyes, etc. These should be specific and individualized.
The route of administration: orally, topically, rectally, etc.
The amount of medication that is to be given: two tablets, one applicator, three drops, etc.
How often the medication can be given. This includes:
The maximum dosage that can be given within a 24 hour period.
The length of time the medication can be used or under what conditions and time frame the medication may be used before the nurse or physician should be notified. Examples:
The physician will need to individualize these requirements.
Any specific instructions or warnings that may accompany a medication such as “Do not crush”, “Do not give with a specific medication”, or “Must be taken with food”.
Potential side effects that can occur when taking the medication. These include both physical and behavioral indicators.
Documentation of all medications that are given must occur on the Medication Administration Record (MAR). The information required includes:
a. Name of medication
b. Time and Date of administration
c. Dosage taken by the individual
d. Reason for administering the medication
e. Staff initials
f. In some cases, documenting the results that occurred once the medication was given is also needed.
PRESCRIPTION PRN MEDICATIONS
These medications can only be obtained through the prescribing physician.
When PRN medications which cannot be purchased over the counter are prescribed, the individual’s team must be notified. They can then address any concerns regarding the medication. Although the team cannot override a physician’s order, they may decide to seek a second opinion regarding the use of that medication. At no time should any staff working with an individual request a PRN medication from a doctor except in an emergency situation.
The use of PRN medications is warranted for many different conditions. However, the use of PRN medications for “behavioral” purposes is highly discouraged.
PRN medication protocols for the use of psychotropic medications must have an objective written into the individual’s plan or ordered by a physician. Staff must also be delegated by a on staff RN.
General rules regarding the use of psychotropic medications:
PRN psychotropic medications are never to be used for the convenience of staff caring for an individual, but must have clear and objective guidelines for use.
PRN medications are never to be used in place of behavioral support strategies.
PRN medications are never to be used as punishment. The PRN protocol must contain the following:
The name of the individual receiving the medication.
The name of the PRN medication, including both generic and trade name to avoid confusion.
The dosage of the PRN.
The route of administration: orally, IM, etc.
Potential side effects of the medication that need to be monitored.
Signs of overdose, specifically physical signs and symptoms to look for that may indicate an overdose. The emergency procedure if an overdose is suspected.
The maximum dosage the individual may have per occurrence.
The minimum amount of time allowed between doses.
The maximum dosage or maximum number of times the individual may take the medication in a 24 hour period.
The maximum number of times the individual may receive the PRN in a designated number of days before the individual’s physician should be notified.
The maximum number of times the individual may receive a PRN medication in a designated number of days before the individual’s team should meet to address the issue. This may differ from when the physician should be notified.
The rationale or reason for the use of the PRN medication. This needs to be thoroughly explained in writing and would include:
Antecedents: what may act as a trigger for the behavior?
Precursor behaviors: physical signs, which could include behavioral indicators of pain.
Target behaviors: must be defined in observable and measurable terms.
What steps or supports will be implemented to avoid the use of the PRN medication, if applicable?
The initiation date for the PRN protocol.
Who needs to be notified immediately if a PRN medication is administered, if applicable? Does approval need to be obtained prior to administering the PRN medication?
Documentation, including incident report.
The maximum dosage that can be given within a 24 hour period.
The length of time the medication can be used or under what conditions and time frame the medication may be used before the nurse or physician should be notified. Examples:
The physician will need to individualize these requirements.
Any specific instructions or warnings that may accompany a medication such as “Do not crush”, “Do not give with a specific medication”, or “Must be taken with food”.
Potential side effects that can occur when taking the medication. These include both physical and behavioral indicators.
Documentation of all medications that are given must occur on the Medication Administration Record (MAR). The information required includes:
a. Name of medication
b. Time and Date of administration
c. Dosage taken by the individual
d. Reason for administering the medication
e. Staff initials
f. In some cases, documenting the results that occurred once the medication was given is also needed.
PRESCRIPTION PRN MEDICATIONS
These medications can only be obtained through the prescribing physician.
When PRN medications which cannot be purchased over the counter are prescribed, the individual’s team must be notified. They can then address any concerns regarding the medication. Although the team cannot override a physician’s order, they may decide to seek a second opinion regarding the use of that medication. At no time should any staff working with an individual request a PRN medication from a doctor except in an emergency situation.
The use of PRN medications is warranted for many different conditions. However, the use of PRN medications for “behavioral” purposes is highly discouraged.
PRN medication protocols for the use of psychotropic medications must have an objective written into the individual’s plan or ordered by a physician. Staff must also be delegated by a on staff RN.
General rules regarding the use of psychotropic medications:
PRN psychotropic medications are never to be used for the convenience of staff caring for an individual, but must have clear and objective guidelines for use.
PRN medications are never to be used in place of behavioral support strategies.
PRN medications are never to be used as punishment. The PRN protocol must contain the following:
The name of the individual receiving the medication.
The name of the PRN medication, including both generic and trade name to avoid confusion.
The dosage of the PRN.
The route of administration: orally, IM, etc.
Potential side effects of the medication that need to be monitored.
Signs of overdose, specifically physical signs and symptoms to look for that may indicate an overdose. The emergency procedure if an overdose is suspected.
The maximum dosage the individual may have per occurrence.
The minimum amount of time allowed between doses.
The maximum dosage or maximum number of times the individual may take the medication in a 24 hour period.
The maximum number of times the individual may receive the PRN in a designated number of days before the individual’s physician should be notified.
The maximum number of times the individual may receive a PRN medication in a designated number of days before the individual’s team should meet to address the issue. This may differ from when the physician should be notified.
The rationale or reason for the use of the PRN medication. This needs to be thoroughly explained in writing and would include:
Antecedents: what may act as a trigger for the behavior?
Precursor behaviors: physical signs, which could include behavioral indicators of pain.
Target behaviors: must be defined in observable and measurable terms.
What steps or supports will be implemented to avoid the use of the PRN medication, if applicable?
The initiation date for the PRN protocol.
Who needs to be notified immediately if a PRN medication is administered, if applicable? Does approval need to be obtained prior to administering the PRN medication?
Documentation, including incident report.
BE SURE TO CHECK WITH YOUR EMPLOYER FOR THEIR RULES AND REGULATIONS ON ADMINISTERING PRN MEDICATIONS.
HHS Texas Medication Regulations
HHS Texas Medication Regulations
prnconsulting
WhatsUpJayTee Disclaimer
*The videos linked does not belong to WhatsUpJayTee, for additional information and resources ONLY.
Comments
Post a Comment