Patients (approximately 80%) are likely to receive PRN psychotropic medications whilst in mental health wards (Geffen et al. 2002, Curtis and Capp 2003). The most frequently used PRN psychotropic drugs are; antipsychotics, anxiolytics, hypnotics and anticholinergics. Significantly, PRN antipsychotic medications have been implicated in exposing patients to high doses and polypharmacy (Royal College of Psychiatrists 2006, Milton et al. 1998). In older people’s service antipsychotic and benzodiazepines continue to be used to control agitated behaviour despite the controversy and limited evidence of their effectiveness (Druckenbrod et al. 1993). Prescribing quality for older people especially those with Dementia has been shown to be poor (Harrington et al. 1992). Prescription quality for PRN psychotropic medications in the elderly have been demonstrated to be of worse quality than regular medications (Nirodi and Mitchell 2002). Nirodi and Mitchell (2002) also identified that the quality of prescriptions for dementia illness were inferior to functional ones. A recent study identified that PRN prescriptions for functionally older people when compared to general adult services had more clinical important potential drug interactions (Davies et al. 2007). 

 

This retrospect audit of case notes aims to:

1. To establish the current use of PRN psychotropic medication in older people inpatient settings.

2. To explore the effect of these PRN medications on regularly prescribed treatment.

 

 

Retrospective audit of all selected wards (both functional and organic) patient’s notes (approx. 14 wards across Greater Manchester, totalling approx. 250 patients) previous medication and PRN usage in the past week. To rate the quality of prescriptions (PRN and regular) and documentation associated with the administration of PRN based on good practice principles established in the NICE guidelines of Dementia Care, and guidance from the Royal College of Psychiatry and the Nursing, Midwifery Council (National Institute for Health and Clinical Excellence 2006, Nursing Midwifery Council 2004, Royal College of Psychiatrists 2006).   A previously used audit tools to measure quality would be used (Baker et al. 2008).