Standard Operating Procedure for When required (PRN) medicines in care homes Introduction All health and social care organisations are responsible for ensuring the safe management of all medicines. This procedure is intended to support good practice in the management of medicines that are not given or applied routinely, for example pain killers or laxatives, but only when needed. This also provides clear auditable procedures in place to monitor systems so that the medicines are ordered only when needed and their administration recorded accurately. Organisation within which the SOP applies: All Care homes within NHS Sutton CCG Objectives / Purpose To ensure that the correct medicines, in correct amounts are ordered To ensure that these medicines are recorded correctly when administered To define accountability and responsibilities of individual members and to ensure practice is in line with the regulatory frameworks Scope This Standard Operating Procedure applies to Managers, Nurses and care staff working within Care Homes in NHS Sutton CCG who are responsible for medicines Responsibilities Staff working in the areas who have a responsibility for the safer management of medicines in care homes within NHS Sutton CCG Related Guidelines and Standing Operational Procedures Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities 2009) Regulation 2010 THE HANDLING OF MEDICINES IN SOCIAL CARE Royal Pharmaceutical Society November 2007 The Health and Social Care Act 2008 (regulated activities) Regulations 2014. Safe Care and treatment. Regulation 12 Review Period September 2018 or earlier if indicated Validation process: This guidance has been approved by Sutton and Merton MMC for use in care homes within NHS Sutton Clinical Commissioning Group Author and contributors: Hai To, Care Home Pharmacist, NHS Sutton CCG Acknowledgement: Tania Cook, Specialist Senior Medicines Management Technician Social Care Lead, NHS Nottingham City CCG Date Approved: September 2016
Process Actions Medicines that are used when required should only be ordered if needed and in suitable quantities so that they will be used before they go out of date or treatment changed. Large quantities should NOT be stored in the home just in case When required medicines should not be packaged in Multi Dosage System packs as these have a maximum 8 week shelf-life so will result in waste if not used When required medicines that are still indicated/required and in date, should be kept from one month to the next and the amount carried over recorded on each new month s MAR chart. Provided these stock are still within their use by date. The MAR chart should show what the PRN medicine should be given for e.g. for pain, for constipation, for nausea. If staff are unaware why the medication has been prescribed, contact the prescriber for advice The dose on the MAR chart should show the amount to be given for each dose, how often it can be given and the maximum that can be given in 24 hours. If this is not printed on the MAR chart, contact the prescriber for advice and ask them to include this information on any future prescriptions for the service user Consideration should be given to the service user s capacity to refuse the PRN medicine. For example where the service user is unable to communicate by asking for the medicine, the care plan and the information either on the MAR chart or the sheet in front of their MAR chart should show how the need for the PRN must be identified e.g. if signs of pain are expressed in a non- verbal way External medicines like medicated creams should not be kept just in case as the condition that they are to be used for may be different when they are eventually needed. This may lead to the incorrect medicine being used It is good practice to ask the service user whether they would like their PRN medication when doing the medicine round, in accordance with the dose times that the GP has indicated i.e. don t offer a sleeping tablet in the morning. If the MAR charts used have an offered but not required code, use this to show that the medicine was offered. Where a medicine is used for seizures or angina attacks then these should only be recorded when they are used i.e. no code need be written PRN medication should not be offered or given only at the times listed on the MAR chart or at specific medication rounds. The medicine should be available and be offered at times when the symptoms are experienced either by the service user asking for the medicine or by the staff identifying the person s need Responsible Person Designated Nurse or Home Manager/Senior Carer
All when required medicines should be recorded on the MAR chart when administered showing the quantity given must be recorded, where the prescribed dose is variable i.e. one or two. The actual time administered should also be recorded on the MAR or PRN chart kept with the MAR. This is to assure medication is not over or under dosed. It is good practice to record on the reverse of the MAR chart or on a separate PRN chart why the medicine has been given especially if the medicine is given infrequently for pain e.g. for headache or toothache. The response to the medicine should also be recorded in the care plan e.g. no longer in pain or still in pain If PRN medication is given regularly, a referral to the GP should be considered for a review, as their treatment may need altering. This should also be done if the PRN medicine is not working as expected. If when required medicines have not been used in the previous 6 months then their use should be reviewed by the GP. This includes pain killers which could still be given under the Homely Remedy Guidance
WHEN REQUIRED PRN TEMPLATE The following information must be referred to when offering and administering PRN medication prescribed. This document must be kept at the back of the residents MAR charts for reference. Response to therapy should be recorded in the resident s clinical note or care plan. Residents name: Date of Birth Room Number: Name of medication and start date Form: tablets/syrup/.* Strength: Dose and frequency Route: oral/topical/...* Minimum time interval between doses Maximum dose in 24hours Prescribed/homely remedy/others...* Reasons for administration: when the medication should be given- describe in as much detail as possible the condition being treated i.e. signs and symptoms, behaviours, type of pain- where and when, expected outcome. For creams indicate where it should be applied. Any special instructions e.g. before or after food on empty stomach Predictable side effect : use current BNF or product information leaflet to list these Any additional comment/ information Prepared by: Name and signature Checked by: Name and signature Date: Review date: *Circle as appropriate Adapted from NHS Aylesbury Vale and Chiltern CCG
WHEN REQUIRED PRN COMPLETED EXAMPLE The following information must be referred to when offering and administering PRN medication prescribed. This document must be kept at the back of the residents MAR charts for reference. Response to therapy should be recorded in the resident s clinical note or care plan. Residents name Mrs Nellie Snow Name of medication and start date Lorazepam Strength: 1mg Dose and frequency 1 mg tablet to be taken when required Maximum dose in 24hours 2mg Date of Birth 12/1/1936 Form: tablets/syrup/.* Tablet Route: oral/topical/...* Oral Minimum time interval between doses 8 hours Prescribed/homely remedy/others...* Prescribed Reasons for administration: when the medication should be given- describe in as much detail as possible the condition being treated i.e. signs and symptoms, behaviours, type of pain- where and when, expected outcome. For creams indicate where it should be applied. Lorazepam may be used when Mrs Snow becomes anxious. This usually occurs after a visit by her family; she may ask for her children and become restless and agitated. She may appear frightened, she may withdraw to the corner of the room or walk around. Before administration of Lorazepam : Encourage Mrs Snow to go to a quieter area or to sit with you. Encourage her to verbalise her feelings, acknowledge how important her family are to her. Listen to her. Reassure and orientate her. Use distraction methods, e.g. offer a drink, look at photos or go for a walk with her. Only give Lorazepam if these measures don t work. Lorazepam takes 15 minutes to have an effect. Supervision may be required after administration of Lorazepam, as there may be an increase in levels of confusion, drowsiness and there is an increased risk of falls. Any special instructions e.g. before or after food on empty stomach Grapefruit juice and drinks containing caffeine should be avoided as they can affect the way that Lorazepam tablets work. Lorazepam may increase risk of dependence; avoid prolonged use (and abrupt withdrawal thereafter) Predictable side effect : use current BNF or product information leaflet to list these Drowsiness and lightheadedness the next day; confusion (especially in the elderly); amnesia; dependence, muscle weakness Any additional comment/ information Monitor and record Mrs Snow s response to Lorazepam and contact her GP for advice or review if she appears to be experiencing side effects( see list above) or requests it more frequently than prescribed. If rarely request or regularly declines the PRN medication, contact the GP for review. Prepared by: Name and signature A Blog Senior carer Home manager Checked by: Name and signature B Blog Date: 1 st September 2016 Review date: 1 st September 2016 *Circle as appropriate
Medicine Administration Record for as required (PRN) Medicines Name: DOB: Room Number: Name, form and strength of medicine: Does this medication need to be reviewed by the doctor? Date Time given Dose given Signature Print Name Quantity remaining Adapted from Cambridgeshire Community Services NHS Trust
I have read and understood this standard operating procedure and agree to work to it. Name Job Title Signature Date