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overuse of prn medication in mental health hospitals


Hi everyone, i have a sticky situation that i hoping for assistance. i am 1 month into my new grad program at a voluntary mental health facility . I'm enjoying myself so far and am trying to do my job well to the best of my ability.

However i cannot help feel that i am giving too much PRN medication on my shift . They come and request PRN , say Diazepam and if i ask why they need it most of them just go " i am feeling agitated " or " i am feeling anxious" . Some of these pple do not even look that anxious and sometimes its hard to guage as i dont know them that well yet . Also i know that anxiety is subjective to a certain extent so just because they are not shaking or crying doesnt mean they are okey.

What's bothers me the most is that most times i hardly have time for 1 on 1 talk to try to address the ubderlying issue as i have other duties so i end up sucumbing and giving the PRN . It Makes me feel incompetent and i feel as though i am not doing my job right. The other PRN that i feel is beyond my control is for insomnia because they end up arguing that they" couldnt even sleep last night" , It will be charted and i cannot seem to find a good enough reason to not give it.

What other options can i offer these pple rather than piling Prn on top of regular medication all the time. I fear for drug dependence and increased tolerence.

Please help !!! :(:down:

A better question is why your searching for reasons to not give anxiety and sleeping medications when they've been prescribed? It's great that you want to talk to the patients and find non-pharmacological way of managing their issues, but you said it yourself, as a nurse you're rarely going to have time to sit down and process with patients, this is why therapists exist. Your role in administering PRNs is to ensure that they are administered safely and within the bounds of the clinicians' orders.

Anxiety, like pain, is HIGHLY subjective. If a patient complains of anxiety, don't go hunting for reasons to not give the prescribed meds, even if you have the time to process with him/her.


Specializes in Psych.

I to work psych and hand out prn anxiolytics. I agree that some patients don't present outward s/s. I do manage to ask them what is causing their anxiety to rise, and enter it as "Pt stated". This is what I document in the MAR as cause. This will monitor trend, and is valuable information by assisting the therapist and psychologist to make appropriate changes to their medications, and therapeutic sessions. Also it keeps you actively involved in following medical treatment plans. Remember short concise documentation can protect you from overmedicating, and the patient from becoming to dependent. Hope this helps..........Peace, and happy nursing.