A quality improvement project to increase self-administration of medicines in an acute hospital

Abstract

Quality problem or issueA patient survey found significantly fewer patients reported they had self-administered their medicines while in hospital (20% of 100 patients) than reported that they would like to (44% of 100). We aimed to make self-administration more easily available to patients who wanted it.Initial assessmentWe conducted a failure, modes and effects analysis, collected baseline data on four wards and carried out observations.Choice of solutionOur initial assessment suggested that the main areas we should focus on were raising patient awareness of self-administration, changing the patient assessment process and creating a storage solution for medicines being self-administered. We developed new patient information leaflets and posters and a doctor’s assessment form using Plan–Do–Study–Act cycles. We developed initial designs for a storage solution.ImplementationWe piloted the new materials on three wards; the fourth withdrew due to staff shortages.EvaluationFollowing collection of baseline data, we continued to collect weekly data. We found that the proportion of patients who wished to self-administer who reported that they were able to do so, significantly increased from 41% (of 155 patients) to 66% (of 118 patients) during the study, despite a period when the hospital was over capacity.Lessons learnedRaising and maintaining healthcare professionals’ awareness of self-administration can greatly increase the proportion of patients who wish to self-administer who actually do so. Healthcare professionals prefer multi-disciplinary input into the assessment process.

Inpatient self-administered medication under the supervision of a multidisciplinary team: a randomized, controlled, blinded parallel trial

“…In comparison with nurse-administered medication, self-administered medication (SAM) reduces omitted dosing and medication errors in hospitals and increases patient medication knowledge, adherence, and satisfaction; therefore, it has been encouraged in many hospitals worldwide. [2][3][4][5] Patient's self-administration could save 70 minutes/day for nurses to spend their time in informing patients on their medication. 6 Despite evidence on benefits, SAM implementation among in-patient service has still been limited, including in Thailand.…”

“…6 Despite evidence on benefits, SAM implementation among in-patient service has still been limited, including in Thailand. 4,[7][8][9] It was, therefore, not surprising that patients were lacking knowledge on medication side effects and on how to take medication after hospital discharge which could lead to non-adherence, drug related problems, or readmission. 3,[10][11][12] A study conducted phone interview within 48 hours after discharge from a medical ward reported that only 43% of patients could specify the name of all medications received and 36% could specify the indications of the prescribed medications.…”

“…13 SAM program may involve pharmacists, nurses, or both to educate medication administration to the patient on a case-by-case basis. 4,14,15 SAM education conducted by clinical nurses often only provides simple drug-related information, but simplifying the drug regimen, an important component of the program's success, is more likely to occur if a pharmacist has participated in the multidisciplinary medication education program. 14,16 The national statistical office of Thailand recently reported that Thailand would become a complete aged society in the year 2021, and a super aged society in the year 2031.…”

“…25 SAM has been recommended worldwide to promote patients' abilities in self-managed medications. [2][3][4][5] It has been implemented in acute hospitals in the United Kingdom and Belgium. 7,26,27 The Society of Hospital Pharmacists of Australia (SHPA) Committee of Specialty Practice in Rehabilitation and Aged Care has recommended SAM as a part of the discharge planning process in rehabilitation wards.…”

A comparative risk assessment of dialysis care processes in the home and hospital care contexts

“…The importance of adopting a structured risk assessment for enhancing care of patients is discussed in literature. Several methods for structuring the risk assessment process, are discussed, for example, the Healthcare Failure Mode and Effect Analysis (HFMEA) (McElroy et al 2016;Franklin et al 2012;Rosen et al 2015;Garfield et al 2018;De Giorgi et al 2010), Preliminary hazard analysis (PHA) (Schlatter 2018;Riou et al 2017;Grespan et al 2019Grespan et al , 2007De Giorgi et al 2010), and the Fault Tree Analysis (FTA) (McElroy et al 2017;Rogith et al 2017;Teixeira et al 2016;Ong and Coiera 2010). Nonetheless, owing to the uncertain nature of risks embedded in the clinical care pathways, applying specific risk assessment methods is not straightforward because of factors such as the need for patient records (for quantitative methods), domain knowledge, or user-knowledge on using different methods while assessing risks (Chemweno et al 2018;Beaussier et al 2016;Paine et al 2018).…”