Psychotropic PRN use among older people's inpatient mental health services

Accessible summary•  Concern has been expressed about the use of antipsychotic medicines with older people. •  Antipsychotics prescribed for pro re nata can cause high doses and polypharmacy. •  Pro re nata in these older people's services appeared to be used at lower doses and less frequently than reported in previous studies. •  More research is required to explore alternative non‐pharmacological interventions.Abstract Concerns have been expressed about the use of antipsychotics with older people, particularly in those who have dementia. Pro re nata (PRN) psychotropic medications including antipsychotics are commonly used to manage disturbed and distressed behaviour. This audit aimed to understand the use of PRN psychotropic medications in older people's inpatient mental health services and the quality of prescriptions and nursing documentation associated with this. A retrospective audit was undertaken on 154 patients on 11 wards in three Mental Health Trusts in the North West of England. A proforma adapted from previous research was used to collect data. Eighty‐seven patients were prescribed combinations of 14 psychotropic drugs in 145 different prescriptions as PRN. Seventy‐six doses of PRN were administered to 26 patients (range 1–17 doses). The most commonly administered drug was Lorazepam ( n = 28, 36.8%). Drugs were most frequently administered during the night ( n = 33, 43.4%). The majority of administrations of PRN were not documented ( n = 45, 59.2%). PRN appeared to be used differently (smaller doses and less frequently) in this study compared to previous research of those aged under 65. Further work needs to examine the use of the use of PRN psychotropic medicines and the older person, and focus on developing alternative non‐pharmacological interventions.