'When required' medicines in adult social care

A person-centred care plan should contain enough information to support staff to administer PRN 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.
• Appropriate alternative support. It should also include interventions to use before considering medicines.
• What order to administer medicines where more than one PRN medicine is available for the same condition.
• When to review the medicine and how long the person should expect to take it. For example, specify what to do if someone takes the medicine regularly or does not use it for a long period.
• When to check with the prescriber if there is any confusion about which medicines or doses to give.

Medicines used to manage distress and agitation

You should include people and their families when developing plans to support people who may experience distress and agitation.

Staff should use a person-centred approach to attempt to relieve distress and agitation before making the decision to use a medicine. Staff should be able to access this information at all times.

Follow the principles laid out in:

• STOMP (stopping over-medication of people with a learning disability and autistic people)
• STAMP (supporting treatment and appropriate medication in paediatrics).

You should work with prescribers to ensure that psychotropic medicines are reviewed regularly. Only prescribe these medicines where there is a clinical need. Consider reviewing medicines during annual health checks.

Prescribe PRN medicines to manage distress and agitation for as short a time as possible. Record and review their use. If you have concerns about overuse, contact the prescriber for advice.

Overuse or inappropriate use of medicines to control people’s behaviour may need to be reported as a safeguarding incident. Find out more about reporting medicine related incidents.

Care plans should detail how staff will offer the medicines to the person when they are experiencing the symptoms.

If you are a care home provider, staff should not limit this to medicines rounds or times printed on medicines administration records (MARs).

For homecare, the care plan should describe how staff will manage PRN medicines outside of visit times. This could include family support. The care plan should detail how staff will communicate this to the person, their family and homecare staff.

Medicines record

The medicines policy should tell staff how and when they should be offering and/or administering PRN medicines.

When staff administer PRN medicines, the record should include:

• the reasons for giving the PRN medicine
• how much staff have 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 PRN medicines do not work as expected, for example, if pain relief is ineffective, or if a person no longer needs the prescribed PRN medicines.

Keep PRN medicines in their original packaging. Hold suitable quantities and ensure they are in date.