PRN medicines: would every member of staff make the same decision?
“When required” medicines are often called PRN medicines. They may be prescribed for pain, nausea, constipation, anxiety, insomnia or other symptoms that are not present all the time.
The words “when required” can sound straightforward. In practice, however, staff still need enough person-specific information to decide when the medicine should be offered, how much should be given and what should happen afterwards.
If the written guidance is vague, two competent members of staff may observe the same person and reach different decisions. One may offer the medicine too soon. Another may wait too long. A later shift may not know whether it worked or when another dose could safely be considered.
The answer is not guesswork. It is a clear PRN protocol linked to the person’s prescription, medicines record and care plan.
Four questions before a PRN decision
- What symptom or person-specific cue is present?
The guidance should explain what the medicine is for and what staff should look for. It should not rely only on a generic phrase such as “when agitated” or “for pain.”
Some people can ask for a medicine and describe how they feel. Others may need prompting or may communicate through changes in behaviour, facial expression, movement, sleep, appetite or other individual signs. Those cues need to be understood in the context of that person—not assumed from a label.
- What dose is prescribed, and when was the last dose?
Staff need clear written directions for the dose, the minimum interval between doses and the maximum that may be given within the stated period. Where a variable dose is prescribed, the record should explain when each dose is appropriate.
Before giving a PRN medicine, check the current record and establish whether another dose has already been administered. This is especially important where relatives, visiting professionals or staff on another visit may also provide medicines support.
- What support should be tried first?
Person-centred guidance may identify appropriate non-medicine approaches to try before the PRN medicine, where this is clinically appropriate. The action will depend on the person and the symptom.
For example, staff might first help someone change position, offer a drink, reduce noise, support communication or use an agreed calming approach. These are not substitutes for prescribed treatment when it is needed. They are part of understanding the person’s needs and following the agreed plan.
- What result will be checked and recorded?
The record should show why the PRN medicine was given, the amount, the time where relevant, and whether it was effective. That final point matters. Without an outcome, the next member of staff cannot tell whether the intervention helped.
Repeated use, non-use or poor effect may also indicate that the person’s needs or prescription should be reviewed. Staff should know when and how to contact the prescriber, pharmacist or another appropriate health professional.
A short team check
Choose one PRN medicine record and ask two staff members, separately:
- What signs would lead you to offer this medicine?
- What would you check before giving it?
- What support would you try first?
- How would you know whether it worked?
- When would you seek advice?
If their answers differ significantly, treat that as useful evidence. Review the guidance rather than waiting for uncertainty to become an incident.
PRN should not mean “use your best guess.” Clear, person-centred information helps staff make safer and more consistent decisions—and helps the person receive the right support at the right time.
This article supports staff training and service discussion. It does not replace the person’s prescription, care plan, medicines policy or advice from an appropriate healthcare professional.
Sources
Care Quality Commission: “When required” medicines in adult social care
https://www.cqc.org.uk/guidance-providers/adult-social-care/when-required-medicines-adult-social-care
NICE NG67: Managing medicines for adults receiving social care in the community
https://www.nice.org.uk/guidance/ng67/chapter/Recommendations