What is an appropriate audit protocol for assessing the correct usage of Pro Re Nata (PRN) versus Statim (SOS) terminology in inpatient pediatric records?

Audit Protocol for Correct Usage of PRN vs SOS Terminology in Pediatric Inpatient Records

The recommended audit protocol should focus on standardized documentation of PRN (Pro Re Nata) medication orders, as PRN is the correct and standard terminology for "as needed" medication administration in prescriptions, while SOS is less commonly used and not recommended in modern prescribing practice. 1

Audit Objectives

• To assess compliance with standardized PRN medication documentation in pediatric inpatient records 2
• To evaluate if PRN orders include clear indications for use (e.g., "for pain," "for nausea") 1
• To determine if PRN medications are being appropriately reviewed and discontinued when no longer needed 3
• To verify appropriate documentation of PRN medication effectiveness after administration 2

Audit Methodology

Sample Selection

• Random selection of 20% of pediatric inpatient records from the previous 3 months 3
• Stratify sample to include representation from different pediatric units (general pediatrics, PICU, etc.) 2
• Include records of patients who received at least one PRN medication during their stay 4

Data Collection Parameters

1. PRN Order Documentation

   • Presence of correct PRN terminology (not SOS) in medication orders 1
   • Clear documentation of indication for use (e.g., "for pain," "for fever") 2
   • Appropriate dosing parameters (dose, route, frequency, maximum daily dose) 2
   • Appropriate age/weight-based dosing calculations 2

2. Administration Documentation

   • Time of PRN medication administration 5
   • Documented reason for administration matching the prescribed indication 5
   • Documentation of assessment prior to administration 2
   • Record of effectiveness evaluation after administration 2

3. Medication Review Process

   • Evidence of regular review of PRN medications (at least every 24-48 hours) 3
   • Documentation of discontinuation for PRN medications not used for >1 month 3
   • Appropriate transition plan for PRN medications at discharge 2

Audit Tool Design

• Create a standardized checklist incorporating the above parameters 3
• Include space for qualitative observations about documentation quality 5
• Use a simple scoring system (Yes/No/Partial) for each parameter 3

Implementation Process

1. Pre-Audit Phase

   • Form a multidisciplinary audit team including pediatrician, pharmacist, and nursing staff 2
   • Provide training on the audit tool and methodology 2
   • Establish baseline standards based on hospital policy and guidelines 2

2. Data Collection Phase

   • Review selected patient records using the standardized audit tool 3
   • Document specific examples of good practice and areas for improvement 5
   • Collect data on most commonly prescribed PRN medications 4

3. Analysis Phase

   • Calculate compliance rates for each parameter 3
   • Identify patterns in PRN medication use (timing, frequency, indications) 5
   • Compare practices across different pediatric units 4
   • Identify common documentation errors or omissions 3

4. Reporting and Feedback

   • Present findings to relevant clinical teams and pharmacy committee 2
   • Highlight areas of good practice and areas requiring improvement 3
   • Compare results with previous audits if available 5

Recommended Standards for PRN Documentation

• All PRN medications must use the terminology "PRN" rather than "SOS" 1
• All PRN orders must include clear indications for use 2
• Maximum dose limits and minimum time intervals between doses must be specified 2
• Assessment of medication effectiveness must be documented after each PRN administration 2
• PRN medications must be reviewed at least every 24-48 hours during inpatient stay 3
• PRN medications not used for >1 month should be discontinued or have documented justification for continuation 3

Quality Improvement Recommendations

• Implement standardized PRN order sets in the electronic medical record 2
• Develop mandatory fields for PRN medication documentation including indication and effectiveness 1
• Create automated alerts for PRN medications not used for >1 month 3
• Provide education to staff on appropriate PRN documentation standards 5
• Establish regular audit cycles (quarterly) to monitor improvement 3

Common Pitfalls to Address

• Lack of clear indications in PRN orders (e.g., simply writing "PRN" without specifying "for pain") 1
• Failure to document effectiveness after administration 2
• Continuing PRN medications beyond necessary timeframes 3
• Inconsistent terminology (mixing PRN and SOS) creating confusion 1
• Inadequate documentation of assessment prior to PRN administration 5
• Missing maximum daily dose limits in pediatric PRN orders 2

This audit protocol provides a structured approach to evaluate and improve PRN medication documentation practices in pediatric inpatient settings, ensuring patient safety and standardized care delivery.