A total of 84% of all PRN dose scheduling was made by nonpsychiatrists. While further studies are needed to interpret the significance of this finding adequately, it may represent a cautious approach to the use of psychotropic drugs or reflect their patients’ nature of illness. However, it may also be a reflection of their limited knowledge of psychotropic medications. PRN prescription has its own merit – it allows adjustment of the regular prescription. However, PRN orders put the responsibility of deciding to implement drug therapy on the nurses, sometimes without physicians providing adequate guidelines. Clinically PRN dose scheduling makes sense, but only if clear instructions and adequate supervision are provided to the nurses who are responsible for administering PRN orders.
The potential for abuse of PRN dose scheduling must not be overlooked. Frey et al reported a heavy reliance on drug therapy in patients admitted to hospital with no consideration for other psychotherapeutic interventions. Overuse of PRN orders may increase costs to the institution.
We recognize that these data alone are insufficient to conclude the reasons for and the appropriateness ofthe prescribing patterns described. Despite its limit at ions, however, this study emphasizes that nonpsychiatrists, irrespective of their specialty, prescribe an appreciable number of psychotropic . The data also provide baseline information to monitor future trends in the prescription of psychotropic drugs by specialists, especially as we enter the era of newer, more efficacious psychotropic agents with fewer side effects. We suggest that postgraduate training for specialists incorporate adequate training in psychopharmacology. Continuing medical education on psychotropic drugs, consultation-iiaison by psy-chia try as well as con sid era tion of alter na tive psychotherapeu tic ap proaches when feasible should encourage rational use of psychotropic drugs and improve patients’ quality of life.