PRN medication: beliefs and practices of psychiatrists and nurses working in PICUs and secure units

IntroductionPRN (as required) medication is commonly used in inpatient psychiatry but little is known about staff opinions concerning its use.Aims & objectivesToexplore views about PRN medication among nurses and psychiatrists working in PICUs or secure care at a charitable hospital.MethodA structured questionnaire with visual analogue scales was used to examine staff views about PRN medication. Participants were: 21 PICU nurses, 20 nurses working on medium secure admission units (MSAUs) and 27 psychiatrists. Inquiry was made about preferences and avoidance of PRN drugs and when PRN administration becomes rapid tranquillisation (RT).ResultsNurses working in PICUs and MSAUs held similar views about PRN medication. Nurses were more in favour of PRN medication than psychiatrists, whereas psychiatrists felt more strongly that PRN sedation was sometimes over-used. PICU staff favoured promethazine whereas non-PICU staff preferred lorazepam/lorazepam and haloperidol combined. There was no consensus as to when PRN administration becomes RT.ConclusionsNurses hold more positive views about PRN sedation than psychiatrists. Despite the ECG requirement, many staff favour haloperidol. The NICE definition of RT was not quoted by most participants. RT and PRN medication is a grey area which deserves further exploration.