Protocol for administration of when required Medicines in Care Homes Rationale: MAR charts can become very confusing when completing when required (prn) medicines, particularly when the box size is small and it may be difficult to see the exact quantity, what was, when and by whom. Pre-formatted MAR charts may limit the choice of time when a prn medicine is administered. The best practice forum developed this suggested protocol to minimise the chance or error and to help make prn medicine recording clearer. Procedure: Complete a protocol sheet for any currently prescribed medicine which is to be when required ( prn ). (This will help you know when to offer the medicine.) When the person the medication is prescribed for requires a dose, check that the product is still prescribed and the supply is in date. Only complete the MAR chart or prn protocol administration sheet when the dose of medicine is. Record on the MAR chart or prn protocol administration sheet the date time quantity Signature of the person administering. If the care home manager decides that staff should complete the prn protocol for administration records, then the MAR chart needs to have see prn protocol sheet written on it. Keep a running balance. This makes it much easier to see when a prn medicine is administered and it is easier to track changes in medicines use (i.e. pain relief is being more frequently). This document contains an example of a protocol which can be used on its own if recording administrations on the MAR chart. The document also contains an example of a protocol along with an administration record. Please note that if this is used, the MAR chart should be annotated accordingly e.g. See PRN protocol. Refer to Appendix 1 for examples of how to correctly complete a PRN protocol. If a medicine is very infrequently AND is included in the home s Homely Remedy Policy, the carer should discuss with the Care Home Support Pharmacist or GP the removal of the prn medicine from the resident s regular medicine and administration via the Homely Remedy Policy. The Abbey Pain Scale (appendix 2) can be used to help asses those people who cannot verbalise their pain level
Patient Name Protocol for PRN (When required) and Variable Medicines (Including topical applications and nutritional support) of Birth Room Number Doctor Allergy Status Strength of Medicine If a variable dose please specify how much to give and when Form of Medicine Intervals between If N please document signs to observe that may indicate PRN medication is required Strength of Medicine If a variable dose please specify how much to give and when Form of Medicine Intervals between If N please document signs to observe that may indicate PRN medication is required Completed by Countersigned by Transcribe directly from the pharm acy label/mar sheet Describe in as much detail as possible the condition being treated, e.g. Symptoms, indications, behaviour(s), triggers, types of pain, w here, w hen, etc.
Medication Record PRN and Variable dose Medicines Patient Name of Birth Doctor Room Number Allergy Status Strength of Medicine If a variable dose please specify how much to give and when Form of Medicine Intervals between If N please document signs to observe that may indicate PRN medication is required Completed by Countersigned by Expiry date In Stock Time Given Reason RGN sign Balance
Expiry date In Stock Time Reason RGN sign Balance
Appendix 1 Patient Name John Smith of Birth 01/01/1940 Room Number 1 Doctor Dr Jones Allergy Status Penicillin Lorazepam Strength of Medicine 1mg Form of Medicine Tablets If a variable dose please specify how much to give and w hen If N please document signs to observe that may indicate PRN medication is required Half to one tablet when required Give half a tablet (0.5mg)if very restless/shouting out Give one tablet (1mg) if shouting loudly/showing signs of physical agression Oral Intervals betw een 12 hours Max 1 tablet in 24 hours No John might shout out if feeling anxious To help John feel less anxious Completed by Staff signature 19/07/18 Countersigned by Witness staff signature 19/07/18 Patient Name John Smith of Birth 01/01/1940 Room Number 1 Doctor Dr Jones Allergy Status Penicillin Paracetamol Strength of Medicine 500mg Form of Medicine Tablets If a variable dose please specify how much to give and w hen If N please document signs to observe that may indicate PRN medication is required One or two tablets when required Give one tablet if scoring 0-7 on Abbey pain scale Give two tablets if scoring 8-14+ on Abbey pain scale Oral Intervals betw een No John may be grimacing or rubbing his elbow a lot To relieve John of any pain he may be experiencing 4 hours Max 8 tablets in 24 hour Completed by Staff signature 19/07/18 Countersigned by Witness staff signature 19/07/18
Appendix 2