Corporate Policy & Procedures

Pro Re Nata (PRN) Medication

Approved by:
Vice President & Chief Medical Officer; and
Vice President & Chief Operating Officer

Manual
Policy No. VII-B-40
Date Approved
September 2, 2014
Date Effective
September 12, 2014
Next Review (3 years from Effective
Date)

September 2017

Purpose

The Pro Re Nata (PRN) Medication policy has been developed in order to facilitate a safe,
consistent and effective approach to the prescribing, interpreting, administering,
monitoring and documenting of PRN medications.

Policy
Statement

Covenant Health will ensure there is consistency in the practice of writing PRN orders and
in the interpretation and administration of PRN orders. Communication and education
principles will be used to promote compliance with this policy.

Applicability

This policy applies to all Covenant Health facilities, staff, members of the medical staff,
students and any other persons acting on behalf of Covenant Health.

Health will demonstrate commitment to the safety of all patients, residents and
Responsibility Covenant
1
clients by ensuring prescriber and staff education includes information on the correct
prescribing and interpreting of PRN orders and ensuring that authorized prescribers are
writing appropriate range orders for analgesics.

Procedure

1. All PRN medication orders must comply with Corporate policy VII-B-125, Medication
Orders.

2. Prescribing PRN medications

2.1. PRN medication orders are used when the patients condition warrants
individualized non-scheduled dosing.
2.2. Each PRN medication order shall include the following elements:
2.2.1. dosage or dose range
2.2.2. minimum time interval (fixed time interval) between doses or intended
outcome/effect
2.2.3. route of administration (if more than one route, ensure dose appropriate
for each route)
2.2.4. indication(s) for administration
2.2.5. consider ordering a breakthrough dose for symptom management
between PRN doses

3. Interpreting PRN medication orders

3.1. When interpreting the PRN Order, health care professionals need to determine:

Hereafter, all references to 'patients' includes residents and clients.

Pro Re Nata (PRN) Medication

Date Effective
Sept. 12, 2014

Policy No.
VII-B-40

Page 2 of 4

3.1.1. Which drug to administer,

3.1.2. By which route (if more than one route option), and
3.1.3. At what dose (if range dosing is ordered).
3.2. This decision is made on the assessment of the patient symptoms, knowledge of
the medication to be administered, and the patients previous response to
medication.
3.2.1. The initial dose is based on the clinical assessment, standardized tools,
the indications for the PRN medication and other medications that have
been administered. Examples of standardized tools include, but are not
limited to, protocols, pain scales, caremaps
3.2.2. Ongoing doses are based on the clinical assessment, standardized tools
and effectiveness of prior doses of the PRN medication.
3.3. If the PRN order is unclear, an authorized prescriber must be contacted for
clarification of the order. Refer to Corporate policy VII-A- 5, Clarification,
Alteration, and Refusal to Implement Medication Orders.

4. Administering PRN medication orders and monitoring of patients

4.1. The patient must be assessed prior to and after PRN medication administration.
4.2. Prior to administering a PRN medication, the following must be reviewed
4.2.1.
4.2.2.
4.2.3.
4.2.4.
4.2.5.
4.2.6.
4.2.7.

medication record
regularly scheduled medications
prior PRN dose administered and reason for administration
prior route used for administration
time interval between doses
effectiveness of prior doses
any adverse or side effects of prior doses

4.3. Based on assessment the healthcare professional administering the medication

shall select one dose, from within the prescribed range and time interval, by one
route.
4.4. The health care professional cannot give any more medication under this order
until the next time interval. The health care professional must use or seek an
order for breakthrough symptoms.
4.5. After administering a PRN medication, the following must be assessed:
4.5.1. Effectiveness of the dose administered, and
4.5.2. Any adverse or side effects of the dose administered
Note: Time of assessment must be appropriate to the pharmacokinetics of the
medication given

Date Effective
Sept. 12, 2014

Pro Re Nata (PRN) Medication

Example
Order
2.5 5 mg morphine every 4
hours IV PRN for post
operative pain

Loxapine 2.5 mg- 5 mg IM/PO

every eight hours as needed
in addition to regular doses for
management of aggression.

Policy No.
VII-B-40

Page 3 of 4

Administer
Based on assessment, 4 mg of morphine
administered. On assessment post dose, the health
care professional realizes this has not relieved the
patients pain. The health care professional cannot
give anymore morphine under this order (until four
hours have passed). The health care professional
must follow a separate order or obtain a new order for
breakthrough symptoms.
Based on assessment 2.5 mg IM is administered. On
assessment post dose, the health care professional
realizes this has not managed the symptoms
effectively. The health care professional cannot give
anymore Loxapine under this order (until 8 hours have
passed). The health care professional must follow a
separate order, or obtain a new order for breakthrough
symptoms.

5. Documentation of PRN medications

5.1. All documentation regarding PRN medications must include but is not limited to
the following:
5.1.1. Administration of the PRN medications are recorded on the Medication
Administration Record (MAR) in a consistent format,
5.1.2. The clinical assessment completed prior to administration and pertinent to
the PRN medication, and
5.1.3. The patient assessment following administration including the therapeutic
effectiveness of the medication for the prescribed indication and any
adverse or side effects/symptoms experienced by the patient.
5.2. For additional documentation required for controlled drugs given as PRN
medications refer to Covenant Health Policy/Procedure #III-35, Controlled
Substances.
5.3. Documentation may be electronic or paper and include but are not limited to the
following: Medication Administration Record, flow charts, and nurses notes.

6. Review and discontinuation of PRN medications

6.1. PRN medications should be regularly reviewed for effectiveness, and
discontinued if no longer needed.

Pro Re Nata (PRN) Medication

Date Effective
Sept. 12, 2014

Policy No.
VII-B-40

Page 4 of 4

6.2. Automatic stops will be placed on medications as per facility policy/procedure for
Automatic Stop Orders.
6.3. When a new PRN medication is ordered for the same indication as a previous
PRN medication order all previous orders must be reviewed and discontinued
where appropriate. (For example: If orders for codeine and morphine exist and
Tylenol #3 is prescribed, the codeine and morphine orders require review and
discontinuation, if appropriate.)
6.4. When a new PRN medication order is written for the same medication already
ordered, the previous orders (scheduled or PRN) will be discontinued. (For
example, Morphine 5-10mg Subcutaneous q4h PRN, will cancel out any
previous scheduled or PRN morphine order.)
Note: If the prescriber intends to add a PRN order in addition to a current
regularly scheduled order for the same medication, the new order needs to
include both the regular and PRN doses.

Definitions

Authorized prescriber means a health care professional who is permitted by Federal

and Provincial legislation, her/his regulatory college, Covenant Health and practice setting
(where applicable) to prescribe medications.
Health care professional means an individual who is a member of a regulated health
discipline, as defined by the Health Disciplines Act [Alberta] or the Health Professions Act
[Alberta], and who practices within scope and role.
PRN Medication: Medications prescribed for administration to a patient on an as needed
basis. Includes PRN medication orders for breakthrough symptoms.

Related
Documents

VII-B-245
VII-A-125
VII-B-125
VII-B- 80
VII-A-5

Controlled Substances
Medication Formulary
Medication Orders
Standardized Medication Concentrations
Clarification, Alteration, and Refusal to Implements Orders

References

College and Association of registered Nurses of Alberta, Medication Guidelines, January

2014.
American Pain Society. The Use of As Needed Range Orders for Opioid Analgesics in
the Management of Acute Pain. 2004

Revisions

September 10, 2012