Using Patient’s Own Medication in Hospital: Is it a Safer Approach to Medication Administration?

Brock Delfante

Pharmacist Sir Charles Gairdner Hospital Delivering a

Healthy WA

Background

• Medication supply to patients is a fundamental role of hospital pharmacy departments • At SCGH, medications are currently supplied to inpatients predominantly through an imprest system and through supply of non-imprest medications from pharmacy to the ward • Administration of medication is often facilitated by bedside drawers • There are a number of system characteristics which increase the

likelihood of medication errors

, and contribute to both

time

and

financial

inefficiencies

Background

• POM schemes are used in many countries to streamline supply processes • Benefits include: – Assists medication reconciliation process 1, 2, 3, 4 – Patients can continue taking medications they are familiar with 1, 3 – Pharmacists are aware of what supplies the patient requires 1, 3 – Pharmacists can prepare medicines ready for discharge by knowing what additional supplies are required 1 – Significant cost savings to the hospital 1, 3, 4 • At SCGH, although not encouraged, Nursing Practice Guidelines allow for the use of POMs

•

The aim of this study was to determine potential benefits to medication safety through implementation of a POM scheme at SCGH

Methodology

• Post-operative patients admitted to orthopaedic ward were allocated either to POM group or non-POM group Patients using hospital supplies of medicines only n=18 Patients using POMs n=30 – Total sample n=48 • Information was gathered through a standardised data collection form using the NIMC, PAC documentation and a medication drawer audit to collect data • Exclusions: – Patients taking less than two regular medicines – Patients using a medication administration aid (eg Webster-Pak®).

Methodology

Patient initial presentation to emergency Patient initial presentation to pre-admissions clinic Patient admitted to ward following surgery Supply of required medications from pharmacy Administration facilitated by medication drawer Medications assessed and stored in drawer

Results

Table 1. Patient group characteristics comparison

POMs not used Mean (n=18) Drugs on NIMC a Drugs present in drawer

7.6

9.1

Patient went through PAC

5.5% a Excludes medications for prn use and IV medications

POMs Used Mean (n=30)

8.9

9.6

87%

Total Mean (n=48)

8.5

9.4

56%

P Value

0.1168

0.5174

Table 2. Bedside drawer and NIMC audit results for patients using, or not using POMs during admission

POMs not used n (%) (n=18) POMs Used n (%) (n=30) Total n (%) (n=48) P Value Patients with missing drugs Patients with incorrect drugs

56 72 23 50 35 58 0.0169

0.0343

Patient with a ceased drug in drawer Patient with a drug not charted in drawer

17 56 17 37

Patients who missed a a dose

44 7 a Missed doses consists of those doses marked as “ not available ” on the NIMC by nursing staff 17 46 21 1.000

0.3052

0.0008

Discussion

• Patients who did not use POMs during their admission were at risk of medication errors – Medication administration errors – Missing doses of medications • Many medication errors, including missed doses, are avoidable • Medication drawers containing non-current, ceased, or otherwise altered medications increases the chance of medication administration errors • At SCGH, limited pharmacy operating hours restricts the availability of medications not on imprest to wards. Other factors such as pharmacy or nursing staff workload may also impact supply of medicines. • Using POMs can help reduce these barriers to supply and result in immediate availability of medication to the patient, reducing the number of missed doses likely to be received.

Discussion

• This is in addition to the other documented benefits both to

medication safety

, and to

drug expenditure

– Reduced workload of staff – Improved patient care – Reduction in medication wastage • These all have the potential to save time and money,

and

to improve the care of the patient. have the potential • Previous experience at SCGH has shown that a pre-admissions clinic pharmacist is well placed to facilitate the implementation of a POMs scheme, and that POM schemes themselves

can

successfully be implemented.

Limitations

•

Impact of route and timing of admission of patient

•

Methodological simplifications

– Inclusion/exclusion criteria – Sample population – Variables •

Sample size

Conclusion

• This research illustrates the potential benefits of introducing a POM scheme in SCGH • More research is required to determine the implications of introducing a scheme, as well as identifying the associated barriers and facilitators • Th e “5 rights” of medication administration – Right drug – Right patient – Right dose – Right route – Right time

References

1.

2.

3.

4.

Lummis, H, Sketris, I, Veldhuyzen, S. Systematic review of the use of patients ’ own medications in acute care institutions. 2006. J Clin Pharm Ther, Vol 31, 541-563.

Chan, EW, Taylor, SE, Marriott, JL, Barger, B. Bringing patients Med J Aust, Vol 191, no. 7, 374-377.

’ own medications into an emergency department by ambulance: effect on prescribing accuracy when these patients are admitted to hospital. 2009. Stephens, M. Hospital Pharmacy 2nd edn. London, Pharmaceutical Press; 2011.

James, CR, Leong, CKY, Martin, RC, Plumridge, RJ, Patient expenditure. 2008. JPPR, Vol 38, no. 1, 44-46.

’ s own drugs and one-stop dispensing: Improving continuity of care and reducing drug