1.5. Describe how ‘as required’ (PRN) medication can be used to support individuals with dementia who may be in pain

This guide will help you answer 1.5. Describe how ‘as required’ (PRN) medication can be used to support individuals with dementia who may be in pain.

‘As required’ medication, often called PRN, stands for “pro re nata,” meaning “when necessary.” This type of prescription does not have strict times for taking the medication. Instead, the medication is given when the person shows signs or symptoms that the medicine can support.

For people with dementia, pain can be hard to express. They may not always tell staff or family they are in pain. PRN medication can help by easing pain at the right time, rather than waiting for the next regular dose.

PRN medication can be painkillers, but sometimes includes medication for anxiety, sleep problems or agitation too. The most common PRN painkillers in dementia care include paracetamol, ibuprofen or codeine. A doctor prescribes these. Care workers can offer them only when needed and only at the dose and interval set out in the prescription.

Signs of Pain in People with Dementia

People with dementia often struggle to put pain into words. Many have problems with communication. Workers need to notice other signs that might show someone is in pain. These can include:

• Facial expressions, such as grimacing, frowning or looking distressed
• Making noises like groaning, sighing or shouting
• Being restless or unable to get comfortable
• Refusing food or drinks
• Changes in movement, such as limping or guarding part of the body
• Being withdrawn or not wanting to take part in activities
• Sudden changes in mood, such as becoming angry or upset

Families or friends may spot these changes before staff. Staff should listen to what relatives say, as they often know the person’s normal behaviour.

The Role of PRN Medication for Pain in Dementia

Using PRN medication can make life more comfortable for an individual with dementia. When someone with dementia appears to be in pain, offering PRN pain relief helps them relax, sleep and participate in activities.

Benefits of PRN use:

• Offers fast relief from pain
• Does not give extra medicine when there is no pain
• Avoids overmedicating, which can happen if painkillers are given automatically
• Restores comfort and improves quality of life
• Can prevent symptoms like aggression that are caused by unrecognised pain

Workers need to think carefully before giving PRN medication, checking it is really needed. Sometimes pain is caused by hunger, needing the toilet, or an uncomfortable position. It is best to think about these first.

Assessing the Need for PRN Pain Relief

Assessment means checking if a person needs pain relief before giving any PRN medication. This protects the individual from unnecessary drugs and possible side effects.

Things to check:

• Non-verbal cues (see above)
• Verbal cues if the person can still speak
• Reports from family or friends about changes in behaviour
• Physical check, for injuries or sources of pain
• Previous patterns – does pain usually come at a certain time of day or after an activity?

Some organisations use pain assessment tools designed for people with communication problems. For example, the Abbey Pain Scale or the Pain Assessment in Advanced Dementia (PAINAD) tool. These make it easier to decide if pain relief is needed.

Workers should record their findings and any action taken, even if no medication is given.

Following the Care Plan and PRN Protocols

Each individual with dementia should have a care plan. This will set out usual signs of pain and how pain is normally managed for that person. It will also say which PRN drugs can be used, at what dose, how often, and which method (such as tablets or liquid).

Some care homes use a PRN protocol. This is a simple guide, set by the prescriber, explaining:

• When to give the PRN
• What signs to look for first
• How much to give and at what intervals
• What to do if the medication does not work

Workers must only give PRN medicine if it is prescribed, and only in line with the care plan and protocol. Giving a different dose, too soon, or to the wrong person is classed as a medication error.

Keeping the Individual Safe

Safety is key when using PRN medication. Several points protect the person:

• Check the medicine is prescribed for the right person
• Confirm the medicine has not been given recently
• Double-check the dose and when it was last given
• Look out for allergies or interactions with other medicines
• Monitor the individual after giving the medicine – did it relieve the pain? Did side effects appear?
• Record everything: when, what, dose, reason, outcome
• Speak to a senior or seek medical advice if pain continues, worsens, or if you are unsure

This prevents mistakes and avoids harm.

Communication and Consent

People with dementia might not be able to give full consent. Even so, it is important to explain what you are doing. This helps the individual feel respected and dignified. Use simple language and watch their body language.

If the person refuses their medicine, do not force them. Record their refusal and try again later, if safe. If pain continues, call for advice.

Speak with family or advocates if the person cannot make their own choices. They can give important background about how the person usually behaves when in pain.

Workers should regularly share information about PRN use with the wider care team. This helps spot patterns, avoids double dosing, and links medication use to behaviour changes.

Reviewing PRN Use in Dementia Care

PRN medication should not be used on autopilot. Regular reviews check how well it is working, if it is still needed, and if the individual’s needs have changed. This usually involves:

• Keeping clear records of each dose
• Reflecting on whether the medicine helped
• Reporting frequent PRN use to the prescriber
• Discussing pain management at multi-disciplinary meetings

Sometimes painkillers need to move from PRN to being given regularly if pain is ongoing. If side effects develop, the drug may need changing. Regular reviews help keep the individual safe and comfortable.

Recording and Reporting

Every dose of PRN medicine must be recorded. The record should give:

• Name of the medicine
• Dose given
• Time and date
• Who gave it
• Reason for use – for example, signs of pain
• Outcome – did the pain go or did the person settle?

Any errors, refusals, missed doses or side effects should be written in the care records and reported to a supervisor straightaway.

This creates a clear record and supports safe practice.

Supporting Good Pain Management

Medication is only part of good pain management. Alongside PRN painkillers, try other approaches:

• Move the person or provide a comfortable chair or cushion
• Offer a warm blanket or heat pad, if safe
• Encourage rest
• Give gentle massage (if appropriate)
• Provide drinks and snacks if the person may be hungry or thirsty
• Reduce noise and bright lights if the person is unsettled

Sometimes emotional distress can look a lot like physical pain. Reassurance, calm company or a favourite song may help to settle the person.

Minimising Risks Associated with PRN Medication

Any medication has risks. PRN drugs for pain can cause side effects, especially in older people with dementia. Risks include:

• Drowsiness or sleepiness
• Confusion or agitation
• Slower movements or falls
• Constipation (especially with medicines like codeine)
• Allergic reactions

Care workers need to watch out for side effects. If any develop, seek medical advice. Using PRN medicine too often can mask changes in the individual’s condition. For example, new pain might signal a health problem that needs a doctor.

PRN medicines should always be locked away and only given by staff trained in medication administration.

The Importance of Training and Supervision

Only staff with correct training should give PRN medication. Training covers:

• How to recognise pain in people with dementia
• How to check the prescription and care plan
• Safe storage and handling of medicines
• How to assess if a dose is needed
• What to record and report
• Signs of side effects or adverse reactions

Junior staff or those in training must work under supervision until experienced. If in doubt, ask a senior or a nurse. All medication errors must be reported and learned from.

Legal and Ethical Considerations

Giving medication without consent, or not as prescribed, may break the law. The Mental Capacity Act 2005 guides decision-making for people who lack capacity, including some with dementia. It says any action must be in the person’s best interests.

Record when and why a person is given PRN pain relief. Only give the lowest effective dose. Always put safety, dignity, and comfort first.

Failing to offer PRN pain relief when someone is in pain may be considered neglect. Always report concerns to a senior straightaway.

Involving Relatives and Key Professionals

Relatives can give useful information about past pain, reactions to medicines, and signs to watch for. They may spot issues staff miss, especially if the person has moved into a new setting.

Pharmacists, nurses, and doctors work with care teams to review PRN medication. They help update care plans and ensure medication is used for the right reasons. Open conversations keep everyone informed.

If PRN pain medication is used often or not working, medical staff may review the prescription to try a different approach.

Final Thoughts

PRN medication is an important way to support people with dementia who may be in pain. It responds to the individual’s needs, helping them when pain appears, not before or after.

Recognising pain in people with dementia needs careful observation, good communication, and listening to family. Assessing need before every dose avoids medication errors.

Working within the care plan, following protocols, and recording every action keeps people safe. Staff must remain alert to risks and side effects, only giving medicine when needed, and always putting the person first. Staff must communicate, record, and seek help if unsure or if pain continues.

PRN use forms part of good dementia care, balancing safety, dignity, and comfort for every individual.