Pharmacy directors have institutional responsibilities to promote safe medication use and to employ an efficient drug procurement system. In the survey report­ed here, respondents voiced general concerns about the risks associated with using patients’ own medications, such as the potential for medication error. Despite these concerns, certain practices that might decrease the risk and that might help in compliance with CSHP guide- lines were not universally adopted. These elements include having an approved hospital policy and requiring a physician’s order before a patient’s medication can be administered. Dua17 described the implementation of a “patients’ own drugs” scheme in a university hospital in the United Kingdom. That program used patients’ own medications for all medicines required by hospital patients, included assessments of medications for suitability, and provided formal training for nursing and pharmacy staff in the use of such drugs. Dua asserted that the program attenuated, rather than enhanced, risk management issues by training nursing staff to safely use patients’ own medications when the pharmacy was closed, educating patients about proper medication storage at home, reducing the risk of poor-quality drugs being administered, providing criteria for destroying expired or unusable medicines, and removing duplicate drugs from the patient’s possession just before discharge. The hospital determined that the program was cost-effective (i.e., saved more in drug costs than the cost of staff needed to run the program).

Cost savings from the use of patients’ own medica­tions was an important feature for many of the Canadian hospitals that responded to our survey. One Nova Scotia hospital, which used patients’ own medications only when necessary, reported saving $30 000 annually. An Ontario hospital that actively encouraged the use of patients’ own medications stated that savings had been confirmed by formal evaluation; at that hospital, the process for using patients’ own medications had been in place for at least 10 years, but no further details about the program were given. Two hospitals that actively encouraged the use of patients’ own medications, one in New Brunswick and one in Nova Scotia, had conducted audits. The New Brunswick hospital, which used all of the patient’s personal medications where appropriate, has published its results.18 Pharmacy staff assess the medications of newly admitted patients for suitability of use. In 1995, the estimated cost avoidance was $32.70 per admission or $200 000 per year. The savings supported a staff of 2.5 FTE for the program, which has also allowed pharmacists to contribute to patient care. According to the survey reported here, the Nova Scotia hospital also encouraged the use of patients’ own medications, demonstrating per-patient cost savings of $28.03 in 1996 and $38.07 in 1998. Again, the rationale for using patients’ own medications was related to patient outcomes, through improved understanding of how to use their medications and potential reduction in hospital admissions because of drug-related problems. Notably, however, these audits were not formal analyses.Limitations to this national survey included the nonrandomized nature of the sampling, which limits generalizability. Only hospitals with e-mail addresses that had participated in the national Hospital Pharmacy in Canada survey were invited to participate in the survey reported here. Responses were not matched to the e-mail addresses to which the survey was sent; as such, data might have been provided by hospitals that received the electronic survey through forwarding from a pharmacy director on the original e-mail list (rather than directly from the survey authors). It is not known if the characteristics of nonrespondents differed from those of respondents. The overall response rate was moderate (52%), although within the typical range for mail surveys to professionals. Surveys were not returned anonymously, and it is therefore possible that respondents were not completely candid about their hospital’s policies or practices (to avoid criticism). canadian discount pharmacy

It is recommended that institutional policies be established to describe identification, storage, and documentation procedures for patients’ own medications and thus to address pharmacy directors’ concerns about safe and efficient use and procurement of these medications. Programs that encourage the use of patients’ own medications should be evaluated to identify the benefits and risks to patients and to the hospital, to determine the effect on human resources, and to determine cost-effectiveness.