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Policies Relating to Patients’ Own Medications

The majority of hospitals (72% [62/186]) had an approved policy on this topic, and the proportion was similar for single-site hospitals and those that were part of a region or authority. In 70% (57/82) of the hospitals, institutional policy required a written physician’s order (i.e., a specific indication in the patient’s chart) to use patients’ own medications; this percentage was slightly lower (63% [27/43]) among multisite hospitals. The pharmacy was most commonly the department solely responsible for the policy on patients’ own medications (57% [36/63]), but this duty was also frequently shared between pharmacy and nursing (27% [17/63]). In other hospitals, the policy was primarily developed by the pharmacy and therapeutics committee alone (5% [3/63]); by pharmacy, nursing, and the pharmacy and therapeutics committee (3% [2/63]); by the pharmacy, nursing, and risk management departments (3% [2/63]); and by pharmacy and the pharmacy and therapeutics committee (2% [1/63]). Stakeholders involved in development of the policy, besides pharmacy and nursing, included medical staff (72% [44/61]), hospital executives (33% [20/61]), risk management staff (25% [15/61]), the legal department (13% [8/61]), the provincial government (8% [5/61]), hospital committees (7% [4/61]), the quality assurance department (3% [2/61]), patient representatives (2% [1/61]), and the provincial pharmacy regulatory authority ((2% [1/61]).

Pharmacy directors were asked about challenges to the development and implementation of policies related to patients’ own medications and any potential solutions, which were grouped into 6 themes (listed in Table 3). In terms of the associated workload, one institution reported that a program for using surgical patients’ own medications had been cancelled because of lack of staff to run the program; another had delegated some of the duties to a pharmacy technician.
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Table 3. Main Challenges and Proposed Solutions in Development and Implementation of Policies Related to Patients’ Own Medications, as Identified by Survey Respondents (n = 26)


General Issue


Specific Challenges


No. of Hospitals


Proposed Solutions


Compliance



Lack of compliance with policy by nursing and pharmacy staff (e.g.,
failing to verify patients’ own medications; orders specifying “use home
meds”)


12

Provide
education and distribute


memoranda to reinforce existing policy •Have pharmacy staff go to
nursing unit


to verify patients’ own medications

Develop policy to require complete written prescriptions for use of
medications brought from home


Legislation


  • Canada Health Act


  • Provincial legislation


  • Private insurers


  • Pharmacy regulatory authorities (e.g., provincial college of
    pharmacists)


11

Seek
legal opinion

Allow
voluntary use of patients’ own medications with patients’ consent

Allow
use by short-stay patients and those with chronic conditions


  • Use only when the drug is not available from hospital pharmacy


  • Modify regulations of the local pharmacy regulatory authority

Replace
medications on discharge


Process

Verification
and storage of patients’ own medications


  • Policy to be followed if pharmacy is closed

Refills


  • How to develop, enforce, and communicate existing policy


10

Use
formulary system to communicate policy


Public and staff awareness

Answering
questions about why


patients’ own medications are used

Public and staff acceptance of use


of patients’ own medications •Changing culture so that patients’ own
medications are brought to the hospital


9

Communicate
with patients through hospital preadmission procedures

Offer
formulary alternatives if the patient chooses not to use his or her own
medications


  • Provide patient education and written materials explaining the
    policy


  • Ensure that patients are aware that participation is voluntary


Communication

With
health providers •Across multiple hospital sites


6

Offer
in-services, distribute memoranda, and hold interdisciplinary meetings
to disseminate and reinforce policy •Form a new policy communication
subcommittee of the hospital’s pharmacy and therapeutics committee
•Create a pharmacy-generated electronic worksheet to communicate issues
related to use of patients’ own medications to nursing staff


Staff resources



Lack of pharmacist time to process patients’ own medications


4

Use
pharmacy technicians to perform clerical and technical functions of
patients’ own medications program

Respondents reported the following perceived advantages of using patients’ own medications: cost savings (67% [48/72]), decreased inventory (57% [41/72]), reduced delays in therapy (21% [15/72]), continuity of care (19% [14/72]), and increased pharmacist involve­ment in patient care (11% [8/72]). Disadvantages were the potential for medication errors (51% [35/69]), the time required to process them (32% [22/69]), and the loss of medications brought from home (32% [22/69]). Other disadvantages cited were medications not being included in the pharmacy drug distribution system (19% [13/69]), lack of knowledge about when refills are needed (19% [13/69]), delays in therapy while awaiting verification (10% [7/69]), and patient dissatisfaction with using their own medications (9% [6/69]).
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Evaluation of Policies Relating to Patients’ Own Medications

Most hospitals (79% [44/56]) had not evaluated their policy, and some did not know if an evaluation had occurred (5% [3/56]). For those who were aware of an evaluation (16% [9/56]), the purpose was to confirm cost savings (3 hospitals) and to update or make improvements to the policy (6 hospitals). Outcome measures included the number of medication incidents that represented errors of omission, the use of nonformulary medications, the number of times that a nonformulary medication had been obtained by the pharmacy for an inpatient, and the average cost avoided per patient admission when patients’ own medications were used. Cost savings in a Nova Scotia hospital with 200 beds or fewer were reported to be $28.03 per patient admission in 1996 and $38.07 in 1998.