The Use and Management of PRN Medications in Assisted Living

There are limitations as to what an assisted living community can and cannot do in regard to a resident’s medications. In basic terms, the care team of an assisted living community can assist a resident in the management of medication. What this means is that a care team can make prescription medications available to a resident but the resident must administer the dose of medication to his or her self. This includes what are known as PRN medications. 

What Are PRN Medications?

Among the general population, and even among the medical community, we oftentimes hear PRN medications called prescribed as needed (for prescription drugs) and taken as needed (for over-the-counter medications). While prescribed as needed or taken as needed are acceptable terms because that is actually what happens with PRN medications, technically speaking that is not what is meant by PRN. 

PRN as used in medications is actually the abbreviation of a Latin phrase – pro re nata. Pro re nata translates into English meaning “as the occasion arises” or “when necessary.” Thus, prescribed as needed or taken as needed works.

As alluded to a moment ago, PRN medications can be prescription or over-the-counter drugs. In the context of an assisted living community, PRN prescription medications are prescribed by a resident’s doctor. PRN over-the-counter medications can be ordered by a resident’s physician. 

Challenge of PRN Medications in an Assisted Living Community

There is a particular challenge associated with the use of PRN medications in the context of an assisted living community. While other types of prescription medications come with specific instructions as to how and when the drugs are to be taken. The same is not true for PRN medications.

PRN medication may be taken by an assisted living resident when that individual feels that he or she needs the medication. In other words, the administration of PRN medications largely occurs at the discretion of a resident. Yes, the prescribing or ordering physician authorizes use of a PRN medication in the first instance. However, after that juncture the patient (resident of assisted living) makes dosage and administration decisions at his or her discretion.

As an aside, a resident may not be able to explicitly determine that the need for a dose of a PRN medication is necessary. However, as an alternative, if a resident can describe the symptoms that are associated with the need for a PRN medication dosage, that can suffice. The resident must be able to clearly state that he or she is experiencing these symptoms in order to trigger the need to take a dose of a particular PRN medication. 

Role of Physician in Use of PRNs in an Assisted Living Community

In an assisted living setting, a resident’s physician is called upon to prepare a number of different documents in regard to the use of that resident of PRN medication:

  • If the PRN is a prescription medication, a prescription is completed as is the case for any other medication of this type. A copy of the prescription is maintained in the resident’s file or records at an assisted facility.
  • If the PRN is an over-the-counter medication, the physician needs to prepare an order for that drug on letterhead from his or her practice or on a blank prescription sheet. 

As part of a prescription or order for some type of PRN medication, the physician must also provide the assisted living community in writing a specific statement required by California law. The statement must clearly:

  • Identify the name of the resident
  • Identify the name of the PRN medication
  • Set forth when the medication should be discontinued
  • Set forth an indication of when and how the physician will revaluate the continued need for the medication

Specific Requirements of PRN Medication Label in Assisted Living.

The label of a PRN to be used by a resident in assisted living needs to contain the following information pursuant to California law:

  • Symptoms indicating the need for use of the medication
  • Exact dosage of the medication
  • Minimum hours between doses
  • Maximum doses to be given in a 24-hour time period

Patient PRN Medication Use Capacity Form

In addition to the requirements set forth previously in this article, in order for an assisted living resident to be able to use a PRN medication, administration of a facility must develop a form for the resident’s physician to complete. This particular form contains a number of elements:

  • Clearly identifies the extent of a resident’s capacity to determine and communicate his or her needs for a particular PRN medication
  • Clearly indicate a resident of assisted can clearly communicate his or her need for a particular prescription or nonprescription PRN medication and understands the associated symptoms of the condition to be treated
  • Clearly indicate a resident cannot determine his or her need for a PRN medication but can communicate his or her symptoms clearly
  • Clearly indicate a resident cannot determine his or her need for a PRN medication and cannot communicate his or her symptoms clearly

PRN Medication Storage

In theory, California law does allow a resident to store certain medications in his or her apartment or room in an assisted living facility. With that said, assisted living community administrators are encouraged to avoid this type of scenario. Rather, they are encouraged to establish a specific medication storage room or other area. By taking this course, an assisted living is best served ensuring that medications do not end up somehow in the hands of other residents of an assisted living community. 

As is the case with specifically scheduled prescription medications, any errors associated with PRN medications need to be appropriately reported to an assisted living licensing authority with the state of California. 

A resident’s physician in conjunction with the care team at an assisted living community can answer any additional questions a person might have in regard to PRN medications and their management in a long-term care facility, including an assisted living community.