When required medicines in adult social care

Medicines with a PRN (pro re nata) or ‘when required’ dose can treat many different conditions.

Examples include nausea and vomiting, pain, indigestion, anxiety or insomnia.

People with long term conditions may also use when required medicines. For example, inhaled reliever medicines for people with asthma.

There should be a policy for when required medicines.

Care plans

A person-centred care plan should contain enough information to support staff to administer when required medicines. They should be administered as intended by the prescriber. The care plan should include:

• Details about what condition the medicine is prescribed for
• Dose instructions. This includes the maximum amount to take in a day and minimum interval between doses. Where a variable dose is prescribed there should be clear directions as to what dose should be given.
• Signs or symptoms to look out for and when to offer the medicine. Include if the person can ask for the medicine or if they need prompting or observing for signs of need. For example, non-verbal cues.
• The plan should include appropriate alternative support. It should also include interventions to use before medicines.
• Where more than one when required medicine is available for the same condition, it should state how and in what order they will be administered.
• When to review the medicine and how long the person should expect to take it. For example, what to do if the medicine is taken regularly or not used for a long period of time.
• When to check with the prescriber if there is any confusion about which medicines or doses to give.

Medicines used to manage behaviour

For medicines used to manage a person’s behaviour staff should know how to support a person in a different way before using a medicine. For example, changes to the person’s environment.

This information should be accessible to staff at the time of medicines administration.

Providers should follow the principles laid out in:

• STOMP (stopping overmedication of people with a learning disability, autism or both)
• STAMP (supporting treatment and appropriate medication in paediatrics).

Providers should work with prescribers to ensure that psychotropic medicines are regularly reviewed. They should only be prescribed where there is a clinical need. Medicines could be reviewed during an annual health check.

When required (PRN) medicines to manage a person’s behaviour should be prescribed for as short a time as possible. Their use should be recorded and reviewed. If you have concern about overuse you should contact the prescriber for advice.

Overuse of medicines to control behaviour may need to be reported as a safeguarding incident. Find out more about reporting medicine related incidents.

Care plans

Care plans should detail how the medicines will be offered to the person when they are experiencing the symptoms. For care homes this should, not be limited to medicines rounds or times printed on MARs. For home care the care plan should describe how PRN medicines will be managed outside of a visit time. This could include family support. The care plan should detail how to communicate this to the person, family and home care staff.

The plan should also tell your staff what records to make. You might not need to record on the MAR every time a PRN medicine is offered but not taken. For example, glyceryl trinitrate spray is sometimes used for chest pain in angina. You might record this on the MAR only when used.

Another example is pain relief that you assess at each medicine round. You might record this each time you assess it. Or you might only record when it’s given. This will depend on the requirements laid out in the care plan.

Medicines record

When PRN medicines are administered the record should include:

• the reasons for giving the when required medicine
• how much has been given including if a variable dose has been prescribed
• the time of administration for time sensitive medicines
• the outcome and whether the medicine was effective.

You may need to contact the prescriber if medicines do not have the expected effects. For example effective pain relief. You would normally keep when required medicines in their original packaging. They should be held in suitable quantities and be in date.