PowerPoint Template red 2

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Using Patients Own Medication in Hospital Is it
a Safer Approach to Medication Administration?
Brock Delfante Pharmacist Sir Charles Gairdner
Hospital
Delivering a Healthy WA
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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

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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

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

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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 n18
• Patients using POMs n30
• Total sample n48
• 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).

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Methodology
Patient initial presentation to pre-admissions
clinic
Patient initial presentation to emergency
Patient admitted to ward following surgery
Medications assessed and stored in drawer
Supply of required medications from pharmacy
Administration facilitated by medication drawer
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Results
Table 1. Patient group characteristics comparison
POMs not used Mean (n18) POMs Used Mean (n30) Total Mean (n48) 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 () (n18) POMs Used n () (n30) Total n () (n48) 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
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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.

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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.

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Limitations

• Impact of route and timing of admission of
  patient
• Methodological simplifications
• Inclusion/exclusion criteria
• Sample population
• Variables
• Sample size

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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

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References

1. 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.
2. 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.
3. Stephens, M. Hospital Pharmacy 2nd edn. London,
   Pharmaceutical Press 2011.
4. James, CR, Leong, CKY, Martin, RC, Plumridge, RJ,
   Patients own drugs and one-stop dispensing
   Improving continuity of care and reducing drug
   expenditure. 2008. JPPR, Vol 38, no. 1, 44-46.

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