PRN Medications for Blood Pressure and State Survey

 In Blogs

Be mindful of orders for ‘PRN’ blood pressure medication; e.g. “clonidine 0.1mg every 6 hours as needed for systolic blood pressure greater than 160.” Remember these are in essence also orders for routine blood pressure checks. In the preceding example, you would need to document the patient’s blood pressure reading routinely every 6 hours. Otherwise, as many surveyors have noted, you have no way of showing the PRN order for medication was not indicated. In most cases these are acute care orders not appropriate for long-term care patients. Occasionally elevated blood pressures are not clinically relevant, and the medications most often ordered have the potential to cause orthostatic hypotension and increased falls. Prescribers should be encouraged to discontinue orders for ‘PRN’ blood pressure medications and instead check the patient’s blood pressure twice daily for 7-10 days to see if an increase in the patient’s routine antihypertensive medication is warranted. Otherwise it is critical to ensure that all such orders are accompanied by an order for routine blood pressure documentation with a note of the parameter(s) for which the ‘PRN’ order is indicated.

This article was originally published in our monthly issue of From the Front Lines – a monthly publication that shares best practices and medication-related challenges faced by “front line” staff in long-term care and post-acute (LTCPAC) facilities.

>>> From the Front Lines – June 2015 <<<