Medication Education Module 6 PRN Medications Trainer Preparation: Print for handouts; MAP Policy #06-2 Pg 139 from Administering Medications the Right Way Pg 2 “Objectives” to test staff knowledge before and after the training. (Use as your training documentation)

Objectives 1. What is a PRN Medication? 2. When are PRNs given? 3. What are parameters? What I knew about PRNs before the training: 1. 2. 3. 4. What I learned about PRNs after the training: 4. How do you document a PRN?

PRN Abbreviation Meds ordered to be given as needed PRN is an abbreviation for the Latin term Pro re nata. PRN is to give as needed.

PRN Orders Must Include: Frequency Indication(s) Specific target signs and symptoms Instructions for use Parameters The indication must be specific, for example: “Headache” NOT “pain”. The medication may only be administered for the specific indication, for example: if Tylenol is ordered for a headache it may not be administered for a fever. If the medication is topical the site needs to be ordered, for example: “abdominal folds” NOT “to affected areas” Amounts should also be ordered, for example: “1/2 inch” NOT just “apply”

Parameters A limit of doses within a certain time frame and/or When to notify the HCP if symptoms continue A Parameter is a rule or limit that controls how something should be done. An example of a parameter is: Not to exceed 3 doses in 24 hrs. Notify HCP if temperature is 101 degrees or above. When looking at a PRN order ask your self: “What should I do if I give the medication and the person does not improve (symptoms not resolved)?” The answer needs to be included within the HCP order. If it is not, the order needs to be clarified to include this information.

PRN Orders No Ranges For example: 2 tabs NOT 1-2 tabs 10 mls NOT 5-10mls Every 4 hrs NOT every 4-6 hrs 3 times per day NOT 2-3 times per day

Frequency of PRNS Examples Every 4 hrs as needed Every 6 hrs as needed Once daily as needed Every 3rd day as needed If a medication is ordered as a regularly scheduled med and as a PRN the HCP must write how closely the PRN med may be given to the scheduled dose. For an example, see next slide; HCP Order.

HEALTH CARE PROVIDER ORDER Name: Chip Brown Date: 6/1/yr Health Care Provider: Dr. Jones Allergies: no known allergies Reason for Visit: Chip has been pacing more than usual, slapping his head and telling staff he feels weird inside. Current Medications: See attached med list Staff Signature: John Smith, Program Manager Date: 6/1/yr Health Care Provider Findings: After discussing with Chip about how he is feeling we have agreed to try additional Ativan to help him feel less anxious. Medication/Treatment Orders: Add Ativan 0.5 mg once daily PRN anxiety by mouth Give at least 4 hrs apart from regularly scheduled Ativan doses. Refer to Behavior Support Plan. Continue with current medications: Ativan 0.5mg twice daily by mouth Capoten 25mg one time a day in the morning by mouth. Instructions: Follow-up visit: Lab work or Tests: Signature: Dr. Jones Notice the frequency; Ativan 0.5 mg is ordered twice daily and once daily PRN, give at least 4 hrs apart from regularly scheduled Ativan doses. So if the twice daily Ativan is scheduled to be given at 8am and 8pm and the last dose given was at 8am, what is the soonest time Chip could possibly receive a PRN Ativan dose? (12pm). Also, the order states “see behavior support plan”.

Support Plan for use of PRN Medication for Anxiety Specific behaviors that show us Chip is anxious: Pacing in a circle for more than 4 minutes. Head slapping for longer than 30 seconds or more than 5 times in 4 minutes. Staff will attempt to engage Chip in one on one conversation re: current feelings and difficulty. Staff will attempt to direct and involve Chip in a familiar activity such as laundry, meal preparation, etc. If unsuccessful with A or B staff may suggest/offer Chip: Ativan 0.5mg once daily as needed by mouth. Must give at least 4 hours apart from regularly scheduled Ativan doses. (Refer to HCP order) If anxiety continues after the additional dose, notify HCP. 6/1/yr Dr Jones The support plan gives additional parameters for use. A copy of the Support Plan should be kept with the HCP orders as a reference for use and reviewed/updated yearly by the HCP. The Support Plan describes the signs and symptoms of Chip’s anxiety, gives measurable criteria for use and includes when to notify the HCP if the PRN is unsuccessful.

Pharmacy Label Rx # C138 ABC Pharmacy 555-555-1212 20 Main Street Anytown, MA 09111 8/31/yr Chip Brown Lorazepam 0.5 mg Qty. 30 I.C. Ativan 0.5 mg Take 1 tablet by mouth twice daily and 1 tablet by mouth once daily PRN, anxiety, give at least 4 hrs apart from regularly scheduled doses, see behavior plan. The pharmacy supplied one label which includes the instructions for both the scheduled and PRN doses. (Because the strength of the tab is the same). It also states, see behavior plan, as part of the instructions for use.

Documentation Med Sheet in the corresponding date/time box Your initials Time Progress Note Medication and dose Your name Date and time Medication effectiveness

Medication Sheet The PRN Ativan is transcribed in a separate box on the MAR from the scheduled Ativan. Documenting accurately on a med sheet is key to safe med administration. It is important to document the time of administration in order to correctly administer any future doses and to prevent medication occurrences.

Progress Note 9/1/yr 3pm Chip is pacing and head slapping, unable to redirect, Ativan 0.5mg by mouth given. 4pm, watching TV and smiling. Kathy Mason Be sure to include the effectiveness of the medication. Accurate documentation helps the HCP to determine whether or not the medication is working and whether or not to continue ordering the med.

Crosschecking Must agree HCP Orders Pharmacy Labels Med Sheets HCP orders, pharmacy labels and medication sheets must agree. If the HCP order has multiple instructions try having the pharmacy use simple abbreviations or condense the wording to save room on the label. Example: if the HCP order reads: “in the morning”, the pharmacy label may read: “in am”; HCP order reads; “by mouth”, the pharmacy label may read “oral”.

Questions