Experiences of mental health professionals and patients in the use of pro re nata medication in acute adult mental healthcare settings: a systematic review
Authors: Morkunas Bernadette , Porritt Kylie , Stephenson Matthew 
Published: November 2016

EXECUTIVE SUMMARY

Background
The use of pro re nata (PRN) medication, a medication that is given when needed, as opposed to medication that is given at a regular time, is surrounded by claims of misuse and poor accountability within the mental health setting. Gaining insight into and understanding of the experiences of health professionals’ and patients’ use of PRN medication will assist in contributing to improving education and safety around this common intervention.

Objectives
To analyze and synthesize the best available evidence on the perspectives of patients and mental health professionals (MHPs) with their experiences of PRN medication in mental health settings.

Inclusion criteria Types of participants
Participants considered for inclusion in this review include MHPs working in, and adult patients admitted to, an acute adult mental healthcare setting.

Phenomena of interest
This review will consider studies that investigated the experience of MHPs’ and patients’ use of PRN medication in acute adult mental healthcare settings.

Types of studies
The current review will consider studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research.

Context
The context of the review is acute adult mental healthcare settings with no restriction on geographical location.

Search strategy
The search strategy aims to find both published and unpublished studies. The databases searched include CINAHL, PubMed, Scopus, PsycINFO and Embase. A gray literature search included ProQuest Dissertations and Theses, Mednar and Google Scholar.

Methodological quality
Papers selected for retrieval were assessed by two independent reviewers for methodological validity before inclusion in the review using the standardized critical appraisal instrument from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI).

Data extraction
The standardized data extraction tool from the JBI-QARI was used to extract data from the papers.

Data synthesis
Qualitative research findings were pooled using the JBI-QARI. This involved the aggregation of findings to generate a set of statements that represented that aggregation, through assembling the findings rated according to their quality and categorizing these findings by similarity in meaning. These categories were then subjected to a meta-synthesis to produce a single comprehensive set of synthesized findings that can be used as a basis for evidence-based practice.

Results
Four studies were included in the systematic review. Two studies each from both groups’ perspective. These experiences were combined in one synthesis to look at the issues from mutual perspectives. A total of 40 findings were extracted from these four studies. The findings were grouped into 10 categories and five synthesized findings were developed.

Conclusion

Pro re nata medication use among MHPs and service users is subject to many variables from individual decision making to organizational policies. There are many factors that contribute to MHPs prescribing and administering PRN medications and patients had views and opinions on their use of PRN medication in the acute mental health setting.