Improving the quality and reliability of clinical reviews of psychotropic PRN medicines in a large English mental health Trust.

Background: Psychotropic medicines are commonly prescribed as when required (PRN) prescriptions for inpatients for anxiety, insomnia or as part of a strategy to de-escalate situations that may lead to violence and aggression. While these medicines can provide benefit, safeguards need to be in place to ensure they are regularly reviewed and not overused.

Aim and methodology: To (1) establish baseline practice around the clinical review of psychotropic PRN medicines for inpatients and (2) improve clinical practice around the clinical review of PRN medicines from baseline and the end of the improvement programme.Centrally coordinated, locally driven, improvement programme taking place over a 5-month period between February and June 2024. The programme employed a learning system approach to enable doctors to test change ideas and share areas of good practice as they sought to understand the problem, test different approaches and focus on holding the gains.

Findings: 21 wards participated and at an aggregate level achieved both aims with the recording of clinical reviews in the notes increasing from 89% to 90% and the quality of what was recorded in the notes increasing from 51% to 72%. There were signs of increased adjustments to psychotropic PRN medicines during the programme and in some wards decreased rates of psychotropic PRN administration to patients. However, while overall levels of psychotropic PRN medicine administration benchmarked lower than those reported in other studies, there were significant differences in clinical reviews, prescription and administration rates between a group of wards that fully engaged and partially engaged in the improvement programme.

Conclusions: Employing a learning system approach helped create a context suitable for improvement and led to improvements in the review of psychotropic PRN medicines. Exploring the variation between wards in fully engaged and partially engaged groups of wards could be a next step for the Trust.