PRN Authorization

Recently there has been confusion about the requirements for PRN (as needed) medications. When not handled properly, PRN meds may become a source not only for a deficiency, but also risk for litigation as well. No residential community wants to find themselves being accused of giving meds improperly.

Let’s review the PRN requirements.

Physician Order

We must start with a complete MD order. Go get your medication record book. Open it. Look for a PRN medication. Check to be sure all of the requirements below are listed.

  • Name of drug
  • Strength of drug
  • Exact dose of drug
  • Time frames between doses of the drug
  • Reason for using the drug
  • Maximum dose in a 24 hour period

If you have PRN medications without all of the above order requirements, contact the resident’s MD immediately for a complete order.

PRN Authorization

In addition to the complete order, every resident with centrally stored medications who is taking a PRN medication must have a PRN authorization form signed. Even if the resident rarely uses a PRN med, the authorization is still required. The physician basically has three choices for the PRN authorization:

  1. Resident may determine need for prescription or nonprescription medications. This is my favorite MD statement! We may then give any appropriately prescribed PRN medication as ordered.
  1. Resident may not determine need, but may state symptoms for non-prescription medications. When the MD makes this selection the provider may give OTC (over the counter) medication as the resident communicates the symptoms for the medication. Of course an order must be received for the OTC and followed. However, if the physician makes this selection, then the physician must be contacted prior to each and every dose of a prescription medication.
  1. Resident may not determine need and may not communicate symptoms indicating the need for medication. This is the most difficult order to work with in a residential community. When the physician makes this choice the MD must be contacted prior to each and every dose of medication EVEN OTC medications.

So remember, audit frequently for complete orders as well as PRN authorization forms. Also, do not overlook the importance of appropriate documentation when the meds have been given. Every PRN medication requires documentation of the reasons given and the results of giving the PRN medication, in addition to the name of the drug, strength, dose, date, and time. If you had to contact the physician to give the medication, be sure that is documented as well.

If you need a copy of a PRN authorization, email Mickey at He will be happy to provide you with a copy.

One Response to “PRN Authorization”

  1. Hello, during my my last year medication training I was told that if a doctor prescribes a AS NEEDED medication, we have to offer the medication to the client, for example, the doctor’s order says, take tylenol 350 mg by mouth twice a day as needed for headache, according to the training, I was told that we have to offer the medicine to the client twice daily even if the client didn’t ask for medication, is that really true? I am from San Diego, CA. Thank you,

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