In-patient self-administration of medicine
Frank Booth, RGN. Retired
Given that the central theme of the NHS plan is to empower patients to take an active role in the management of their conditions and that self-administration of medications (SAM) by patients in hospital improves compliance and comfort and empowers patients as they are actively involved in their care, you would think that this was sensible. However, a Healthcare Commission report in 2001 had shown variability in the uptake of self-administration policies in different NHS trusts . By 2005/6 little progress had been made; only 19.5% of eligible wards offered patients the opportunity to administer their own medicines . Even by 2013, little progress had been made given that in a letter to the Journal of Physicians journal, Ahmed et al posed the question: ‘Self administration of medicines by inpatients: are we making any progress?’ .
And indeed, this was something I pondered about following a reasonably long stay in hospital for heart decompression. I am diabetic and have managed this for quite some time – however, despite a Joint British Diabetes Societies for Inpatient Care Group report which encourages patients with diabetes to self-administer and adjust insulin in collaboration with a healthcare professional [4and a wealth of evidence supporting the benefits of inpatient self-administration [5,6,7,8], SAM varied between wards. Whilst on one ward I was assessed as competent to SAM drugs and insulin, on another, I was absolutely not allowed; my drugs were locked in a metal cabinet attached to my locker, although I was however left with the insulins…
Staff should realise that SAM can promote patient autonomy. The initial investment on resources such as individual bedside cabinets and additional staff training in facilitating SAM can be offset by the long-term benefits to patients, reduction in prescribing errors and reduction in nurses’ drug administration time. In the current financial climate where the impetus is on increasing productivity, the focus would be on training current staff to learn new skills and work differently to adapt to a changing policy.
It has to be the intention of staff on a ward to prepare patients for discharge - home if that's where they are going and perhaps many, like me live alone and therefore self management at all things is critical.
It should not be too difficult or time consuming to judge a patients competence to self administer, bearing in mind that not everyone would want to do this, nor is everyone competent. But it seems obvious to me that going through the prescription list at the bedside whilst the patient self administers would give staff the opportunity to feel more confident in this process. I can assure you that it took less time for the nurse to be present whilst I self administered than it did later whilst they tried to find the correct drugs themselves.
It's not always easy to change practice, but because it's not easy does this mean that we should not do it? The All Wales Medicines Strategy Group states ;
If a patient wishes to self-administer their medicine whilst in hospital, they should be supported to do so where possible. Health boards or trusts must have procedures to facilitate the self-administration of medicines by a patient. The procedure must include guidance for assessing the ability of a patient to self-medicate. This assessment must be undertaken by a suitably trained healthcare professional, and be documented in the patient notes and retained in the patient file.
Yes, I have been in hospital where a so called "Patient self medication" was practiced. My meds were in the locker, but locked up and could only be opened by the nurse. In my opinion it was a complete waste of time, efficiency having medication supposed to be given before breakfast, and finding regularly my meds being given at 9-10:30, which leads to the dilemma do I eat my breakfast or wait to take a med 1/2 before eating!
We patients are a person like you, most of us are NOT children, most of us have our marbles. We take responsibility of our life not wrapped up in cotton wool all of the time. In hospitals we lay in bed putting up with Victorian attitudes that quite frankly has to stop!
The healthcare industry and patients need to start proactively thinking. How can patients help to make your lives easier. Yes it is a fine line, identifying those patients who can and cannot take responsibility and those you have to protect.
Maybe quite soon the nurses meds round will become a check round to see if the patient have taken and recorded their meds. The right meds, the right time, every time, by the patient!
Well readers a hot topic, what do you think, tell the editor!