Mental health nursing student Kirsty Killiard implemented a system for monitoring the use of ‘as required’ medication for patients on a forensic learning disability ward, earning her a place as a finalist in the RCNi Nurse Awards

While on placement on a forensic learning disability ward at the beginning of my third year as a mental health nursing student I noticed that patients sometimes needed  ‘as required’ (PRN) medication for distress associated with their mental health. 

It was an all-male ward for patients aged 18-65 with a learning disability who were detained under the Mental Health (Care & Treatment) (Scotland) Act 2003. The men had varying levels of learning disability, and more than half had a co-morbid mental illness such as schizophrenia.

On previous mental health placements I had gained experience working with documentation and monitoring aids that highlighted the frequency of use, reason for and review of PRN psychotropic medication. This provided staff with a way of measuring how often patients needed PRN medication and its effectiveness. 

Unmet needs

Such a system enables staff to spot patterns regarding the administration of PRN medication, and identify potentially unmet needs of the patients. Staff can then initiate discussion with the patient and multidisciplinary team to establish if additional support or an increase in medication is required.

Throughout my training I have learned it is important to speak up when there is the potential to improve practice. After spending time on the ward and reflecting on the monitoring systems I had seen on previous placements, I felt it would be beneficial to highlight how often patients were using PRN medication. 

I approached the consultants, senior nursing team and my mentor with the idea of implementing such a system on the ward. This would enable staff to review the drug used, the frequency, the reason for use and its effectiveness. 

I sourced and implemented this independently with staff support, and helped train staff in its use. The system is now in place on the ward.

Before starting this placement I had been anxious about working with such a complex client group, having never worked in this environment before. But implementing this system helped me become more independent and confident in my convictions and aspirations. 

Fresh outlook

I am not studying learning disability nursing – I am training to be a mental health nurse – but I soon realised how important my knowledge and skills are to this patient group. They add value because I could offer an alternative perspective and a fresh outlook. 

I was given support to act autonomously, build up my clinical skills and exercise my judgement to improve patient care. I also realised that although I was a student, my ability to recognise a potential deficit in care was well-founded and led to a positive change on the ward. The monitoring system has since been adopted in another ward in the hospital and is being used to good effect.

This experience showed me the significant role mental health nurses can to play in caring for patients with a learning disability. I was able to implement changes that will assist in informing patient care, and hopefully highlight any causes for concern as early as possible.

Kirsty Killiard is a third-year mental health nursing student at the University of Dundee and a finalist for the Andrew Parker Student Nurse award in association with RCN Fellows at the 2017 RCNi Nurse Awards