patients' own medications

INTRODUCTION

Patients’ own medications are medications that patients have obtained in the community setting and have brought with them to the hospital on admission. Patients may be allowed to use their own medications in some Canadian acute care institutions. This may be necessary to avoid interruptions in drug therapy when the medication is not stocked or is not included in the hospital’s drug formulary. The reported benefits of using patients’ own medications include continuation of familiar, established therapy; better compliance after discharge; less drug waste within the health care system; and potential cost savings to the hospital.

There is concern that the use of patients’ own medications may contravene federal legislation, specifi­cally the Canada Health Act, which stipulates that drugs are to be provided as part of hospital services without cost to the patient. In addition, the practice of verifying and using patients’ own medications can be time consuming, and errors may occur. Potential sources of errors include administering medications in the hospital that have been incorrectly dispensed in the community, and double-dosing if the patient continues to take his or her own medications while receiving drugs provided by the hospital pharmacy.
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In general, the use of medications in hospital is governed by national standards and policies that have been developed with a view to ensuring that best practices are followed, that consistent care is provided, and that patient harm is minimized. The 1993 Guidelines for Practice of the Canadian Society of Hospital Pharma­cists (CSHP) described the safe use of patients’ own medications in Canadian hospitals. The guidelines state that patients who have brought in their own medications are to be encouraged to send those medications home or, if this is not possible, the medications must be identified, stored in a secure area, and returned to the patient at the time of discharge. If patients’ own medica­tions are used, the following elements are mandatory: the hospital has policies and procedures for the use of patients’ own medications within the hospital, patients’ own medications must be verified before administration, and prescribers must write orders for the administration of patients’ own medications. Patients’ own medications that are not returned to the patient are to be destroyed according to local requirements.

The frequency and nature of use of patients’ own medications in Canadian hospitals is not known. In a 1999 survey of the use of therapeutic interchanges in Canadian hospitals with more than 100 beds, Eurich and others found that 186 (88%) of the 211 hospitals surveyed had a therapeutic interchange program. Of these 186 hospitals, 156 (84%) allowed patients to use their own medications if they were taking nonformulary medications at the time of admission to hospital. In the same year, another survey of US hospitals with up to 200 beds revealed that 91% (140/154) of responding hospitals allowed the use of patients’ own medications. The practice of using patients’ own medications has been poorly studied in Canada, and little is known about the content of policies related to patients’ own medications. The objective of the survey reported here was to collect information on the content of institutional policies related to use of patients’ own medications, to determine how such policies have been developed and implemented, to identify any challenges (and possible solutions) to the development of such policies, and to gather opinions about the advantages and disadvantages of using patients’ own medications and the results of policy evaluations, if available. cialis canadian pharmacy