PRN Medication Protocols
PRN (pro re nata) means “as required”. PRN medications are not given at set times but when the resident needs them. Proper use of PRN medication requires clear protocols, good assessment skills, and thorough recording.
What Is PRN Medication?
PRN (pro re nata) means 'as required'. PRN medications are prescribed for use when a resident needs them rather than at set times. Care homes must have clear protocols for when and how to administer PRN medication, and all PRN doses must be recorded on the MAR chart with the indication, time, and response.
Key Principles for PRN Medication
- 1PRN medication should only be administered when there is a clear clinical need — not routinely or 'just in case'
- 2The MAR chart must specify: the indication (when to give), the minimum interval between doses, and the maximum daily dose
- 3Staff must assess the resident before administering PRN medication — is it needed? Could non-pharmacological approaches be tried first?
- 4Record the reason for giving PRN medication (e.g. 'resident complaining of headache', 'distressed and agitated')
- 5Monitor the resident's response after PRN administration and record the outcome (e.g. 'pain relief obtained', 'no improvement — GP contacted')
- 6If PRN medication is being used frequently, this should be reviewed with the GP or pharmacist — the regular prescription may need adjusting
- 7PRN medication must be reviewed as part of the regular medication review cycle
- 8Never administer PRN medication without a current prescription on the MAR chart
Recording PRN Medication
Every PRN dose must be recorded on the MAR chart. Unlike regular medication, PRN entries require additional information:
- •Indication— why was the medication given? (e.g. “resident reporting headache”)
- •Time administered — the exact time the dose was given
- •Dose given — the specific amount administered
- •Response/Outcome — did the medication work? Review 30–60 minutes after giving
- •Non-pharmacological approaches tried — did you try alternatives first?
Common PRN Medications
| Medication | Indication | Max Daily Dose | Min Interval |
|---|---|---|---|
| Paracetamol | Mild-to-moderate pain, low-grade pyrexia | 4g in 24 hours (8 x 500mg tablets) | 4–6 hours |
| Ibuprofen | Inflammatory pain, musculoskeletal pain | 1.2g in 24 hours (unless otherwise prescribed) | 6–8 hours |
| Lorazepam | Severe anxiety, acute agitation (Schedule 3 CD) | As prescribed | As prescribed — usually 4–6 hours |
| Diazepam | Anxiety, muscle spasm, alcohol withdrawal (Schedule 4) | As prescribed | As prescribed |
| Omeprazole | Reflux symptoms, gastric irritation | 20–40mg OD | N/A — typically once daily if needed |
| Lactulose | Constipation | 15–30ml BD–TDS | N/A |
| Co-dydramol | Moderate pain | As prescribed (varies by strength) | 4–6 hours |
| Gaviscon / Antacids | Heartburn, indigestion | As directed on label / prescribed | 1–2 hours after meals |
⚠️ When to Review PRN Use
If a resident is receiving PRN medication frequently, this should trigger a review. Consider the following thresholds for contacting the GP:
- • More than 2–3 doses of the same PRN medication in 24 hours
- • PRN medication needed daily for more than 3 consecutive days
- • PRN medication not providing adequate relief
- • Any adverse reaction after PRN administration
Non-Pharmacological Alternatives
Always consider whether a non-pharmacological approach could help before giving PRN medication:
- • Pain: Repositioning, heat/cold packs, gentle massage, distraction, companion
- • Anxiety/Agitation: Reassurance, familiar objects, music, reduction in stimulation, one-to-one time
- • Constipation: Encourage fluids, increase fibre, encourage mobility, abdominal massage
- • Nausea: Fresh air, ginger, small frequent meals, position adjustments
- • Insomnia: Reduce evening stimulation, warm drink, night light, comfort measures