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Pro re nata (as needed) medication in nursing homes: the longer you stay, the more you get?

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

Injudicious pro re nata (PRN) or as needed prescribing can lead to polypharmacy, potentially harmful drug interactions and total drug doses exceeding the maximum recommended. Despite the known risks and the widespread administration, there is a paucity of current research examining the use of PRN drugs in nursing homes. Therefore, we examined characteristics of PRN drug use and potential predictors in nursing homes.

Methods

The multicentre cross-sectional study included a heterogeneous sample of 21 nursing homes in Northwestern Germany comprising 852 residents. Descriptive statistics and multivariable regression models were used to analyse and present the collected data.

Results

Nearly three quarters (74.9 %) of all residents were treated with at least one PRN medication. On average, each resident was prescribed 2.5 ± 2.3 PRN drugs. On average, residents with no PRN prescriptions stayed since 2.4 ± 2.9 years in the nursing home. Residents with five and more PRN prescriptions were on average since 4.8 ± 4.3 years in the nursing home. In a multivariable analysis, length of stay above the median of 2.1 years (OR 2.4; 95 % CI 1.8, 3.2) and polypharmacy with five or more long-term drugs (OR 2.1; 95 % CI 1.5, 2.9) were associated with a higher number of PRN prescriptions. Most commonly used PRN drug was acetaminophen, which was prescribed to 289 (33.9 %) residents.

Conclusions

The high prevalence of PRN medication should be taken into account when considering polypharmacy and inappropriate drug prescribing or using screening tools like the STOPP/START (screening tool of older persons’ potentially inappropriate prescriptions/screening tool to alert doctors to right) criteria in nursing homes. Physicians should regularly reconsider the need of each PRN drug on the medication schedule. Moreover, the high prevalence of PRN medication and the association with length of stay highlights the importance of an accurate documentation.

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Acknowledgments

The authors would like to thank Mandy Köhrmann und Katharina Allers for the electronic recording of the questionnaires, Birgitt Wiese for the biometric support, and Daniela Boeschen and Jana Petersen for the organisational and scientific support. We would also like to thank all participating nursing homes and Christian Scholz for the technical support.

Author’s contribution

F.H. initiated the study, coordinated the data analysis and developed the study protocol. M.D. developed the study protocol, performed the analyses and wrote the manuscript. G.S. developed the study protocol and provided clinical expertise. All authors commented on manuscript drafts.

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Authors and Affiliations

  1. Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstrasse 140, 26111, Oldenburg, Germany

    Michael Dörks & Falk Hoffmann

  2. Institute for Public Health and Nursing Science, Department for Health Services Research, University of Bremen, Bremen, Germany

    Guido Schmiemann

Authors
  1. Michael Dörks
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  2. Guido Schmiemann
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  3. Falk Hoffmann
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Corresponding author

Correspondence to Michael Dörks.

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Ethical approval

The study was approved by the Ethics Committee of the University of Bremen.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Keypoints

• Pro re nata (as needed) drug use is common in nursing home residents with nearly three quarters prescribed at least one pro re nata drug

• Length of stay in the nursing home is associated with pro re nata medication

• The more long-term medications nursing home residents were scheduled, the more pro re nata drugs were prescribed

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Dörks, M., Schmiemann, G. & Hoffmann, F. Pro re nata (as needed) medication in nursing homes: the longer you stay, the more you get?. Eur J Clin Pharmacol 72, 995–1001 (2016). https://doi.org/10.1007/s00228-016-2059-4

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  • DOI: https://doi.org/10.1007/s00228-016-2059-4

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