Seminar B2: Managing patients’ own drugs in the hospital – empowering patients by redesigning pharmaceutical care

Linked to EAHP Statements:
Section 4: Clinical Pharmacy Services
Section 5: Patient Safety and Quality Assurance

ACPE UAN: 0475-0000-17-017-L04-P. A knowledge based activity.

Abstract 

Patients transitioning from the hospital to home are at an increased risk of medication errors. Patients with discrepancies in their medication list have more hospital re-admissions than patients with a correct medication list. Discrepancies can be due to in-effective medication reconciliation at admission or discharge, substituted drugs during hospital stay or adherence issues not revealed during hospital stay.

Medicines reconciliation is conducted by doctors, nurses or pharmacists. In many cases there is no clear owner of the process. No standardised process exists and in many situations the patient is not well- positioned to provide an accurate medication list at admission, as opposed to later during their stay.

During hospitalisation, approximately 40% of a patient’s medication is being substituted according to the hospital’s formulary. Substitution of drugs may be carried out because of different brands or different strengths in the hospital drug supply. Although this approach is considered as effective and safe, substitution may have downsides with respect to medication safety, patient satisfaction and financial impact. Although medication substitution seems to save money at first sight, staff and medication costs are also involved in order to organise the substitutions.

From a patients’ perspective, substitution should most likely be discouraged. Not only are patients at higher risk for medication errors during hospital stay, they may also be confronted with drugs that patients are unfamiliar with. Consequently, patients’ engagement in their treatment may be altered.

Adherence to drug regimes is often hard to recognise. Adherence is approximately 50 % of prescribed medications. The ability to understand instructions and handle packages are two examples of adherence problems that are not often asked about.

This is supported by the fact that while patients receive care in hospitals, they often assume a passive or dependent role. On discharge, patients (and their family members) are abruptly expected to assume a significant self-management role in their medications, often with little support at home.

This seminar will focus on a new concept of pharmaceutical care delivered during a patient’s admission, in which patient’s engagement and self-administration of medication are key elements. This concept has been tested in several (academic) hospital settings, and was supported by the Dutch Ministry of Health. We’ll present the background of this concept, the first findings as well as a toolbox on how to implement this strategy.

Learning Objectives

After the seminar, the participant should be able to:
• demonstrate address pitfalls in the current medication process;
• apply strategies for pharmaceutical care in order to increase patients’ engagement with treatment.

Keywords: legal aspects, insurance companies, responsibility, liability, quality of meds, trust in patient, safety, pharmacoeconomic issues 

* No conflict of interest has been declared.