As-needed medications (PRNs) are a common part of life for geriatric patients in long-term care and assisted living facilities. They can make things more complicated as well, and I would implore you to review these medications frequently to ensure that they are truly necessary. Here are my top 5 reasons I try to eliminate PRNs when possible.
Masking an Underlying Problem or Adverse Effect
PRNs are often used as a quick fix. For example, using a PRN sedative for “agitation” may delay proper evaluation of pain, infection, or environmental triggers. Similarly, PRN antidiarrheals or laxatives can mask medication-related issues that should be addressed at the root cause. Stopping unnecessary PRNs can force a more thoughtful assessment of what’s actually going on.
Adverse Effects
Common PRNs in long-term care—like antipsychotics, benzodiazepines, opioids, and anticholinergics—carry significant risk. Even intermittent use can lead to sedation, confusion, falls, and constipation. The challenge is that PRN use can be sporadic and harder to track, so adverse effects may not be immediately linked to the medication.
Overwhelming Medication Lists
PRN medications add to the total medication burden, even if they aren’t used every day. In many cases, patients have multiple PRNs on the MAR—pain, sleep, anxiety, constipation, nausea—creating a long list of “just in case” medications. Many of these are no longer necessary, and the list can be exhausting to review for clinicians and pharmacists. Cleaning up PRNs is often one of the easiest ways to reduce overall medication count without disrupting core therapies.
Nursing Burden
From a systems standpoint, PRNs add complexity. Nursing staff must assess, document indications, monitor response, and decide when to give them. The more PRNs on the MAR, the greater the cognitive load and the higher the risk of inappropriate administration or missed documentation. Streamlining PRNs simplifies care and reduces the chance for errors.
In addition, if some of those PRNs are controlled substances, this puts additional administrative burden on medication aids and nurses who have to do additional tracking on those medications.
Polypharmacy
One of the biggest issues with PRNs is that they may not stay “as needed.” Over time, staff may give them routinely based on habit, vague symptoms, or standing expectations. A PRN lorazepam for anxiety or hydrocodone for pain can easily turn into near-daily use without anyone formally reassessing the need. Medications that carry a high risk of dependence can be very problematic and become necessary to avoid withdrawal if given routinely. If a medication is being used frequently, it’s no longer PRN—it deserves a full evaluation or discontinuation.
If you are looking for a full review course in geriatrics, be sure to check out the BCGP Review Course.
What other reasons do you have to get rid of PRNs?
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