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Clinical decision-making for ‘as needed’ medications in mental health care


K. Usher: e-mail:


Title. Clinical decision-making for ‘as needed’ medications in mental health care.

Aim.  This paper is a report of a study exploring the medical and nursing decision-making process associated with the prescription and administration of ‘as needed’ psychotropic medication.

Background.  The administration of ‘as needed’ psychotropic medications is a relatively autonomous component of a nurse’s role, allowing for the capacity to administer psychotropic medications rapidly in acute situations or at the request of a patient. From the research evidence available to date, it is very difficult to determine how doctors and nurses make decisions about the prescription and administration of ‘as needed’ psychotropic medications.

Method.  A qualitative exploratory-descriptive study was undertaken to explore nurses and doctors decision-making surrounding the administration of pro re nata or ‘as needed’ psychotropic medications. Nineteen medical and nursing staff from three mental healthcare sites (acute, secure and rehabilitation) in Australia participated in semi-structured interviews in 2006. Thematic content analysis of the transcripts was conducted independently by two members of the research team and then merged to form the final themes.

Results.  Four themes were identified in the data: decision-making processes; factors which influenced the administration and prescription of ‘as needed’ medication; individual protocols and improving practice.

Conclusion.  In-service education should be developed for mental health nurses on psychotropic medications and ‘as needed’ medications, and on the appropriate use of ‘as needed’ medications as a behaviour management strategy. Further, an extensive review of ‘as needed’ medication prescription and administration compared to best practice guidelines is needed.