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 process1, 2, 3, 4
Patients can continue taking medications they are familiar with1, 3
Pharmacists are aware of what supplies the patient requires1, 3
Pharmacists can prepare medicines ready for discharge by
knowing what additional supplies are required1
– Significant cost savings to the hospital1, 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
Medications assessed
and stored in drawer
Supply of required
medications from pharmacy
Administration facilitated by
medication drawer
Results
Table 1. Patient group characteristics comparison
POMs not used
Mean (n=18)
POMs Used
Mean (n=30)
Total
Mean (n=48)
P Value
Drugs on NIMCa
7.6
8.9
8.5
0.1168
Drugs present in drawer
9.1
9.6
9.4
0.5174
Patient went through PAC
5.5%
87%
56%
-
aExcludes
medications for prn use and IV medications
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
56
23
35
0.0169
Patients with incorrect drugs
72
50
58
0.0343
Patient with a ceased drug in drawer
17
17
17
1.000
Patient with a drug not charted in drawer
56
37
46
0.3052
Patients who misseda a dose
44
7
21
0.0008
aMissed
doses consists of those doses marked as “not available” on the NIMC by nursing staff
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 have the potential
to improve the care of the patient.
•
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
• The “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’ own
medications into an emergency department by ambulance: effect on
prescribing accuracy when these patients are admitted to hospital. 2009.
Med J Aust, Vol 191, no. 7, 374-377.
Stephens, M. Hospital Pharmacy 2nd edn. London, Pharmaceutical Press;
2011.
James, CR, Leong, CKY, Martin, RC, Plumridge, RJ, Patient’s own drugs
and one-stop dispensing: Improving continuity of care and reducing drug
expenditure. 2008. JPPR, Vol 38, no. 1, 44-46.