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Self-administration of medicines by inpatients

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One day Iwas in conversation with a ward manager, who stated that "it would be verydifficult to roll out self-administration of medicines as an initiative in thistrust". Perhaps because the only experiences of hospitals I have had hasoccurred in acute trusts, I have progressed through my journey as anundergraduate and pre-registration trainee with the notion that patients cannotadminister their medicines themselves and that it is a given that a nurse willdo so. I had no idea whether that is right or wrong, but that's what I'vealways assumed.

For the pasttwo weeks, however, I have been on a placement at a mental health hospital andon Tuesday I attended an eye-opening talk by one of the lead clinicalpharmacists about self-administration of medicines by patients.

That thiswas even possible startled me, probably due to my aforementioned preconceptions.The hospital being a mental health hospital made this sound even more bewildering.At this hospital, self-administration of medicines was permitted for a selectgroup of patients who fit the trust's criteria on self-medication.

This doesn'tsound so bad, I thought, as the talk went on. Surely allowing patients to administertheir own medication can only be a good thing. Patients who are fully in controlof their medicines are likely to feel more satisfied with their experience inthe hospital, feel more involved with their treatment and may, consequently,have a better prognosis. Compliance will improve as a result, which could belinked to readmissions, something that costs the NHS a lot of money. Additionally,allowing patients to self-administer will mirror the process as it would occurat home, allow staff to assess how patients will cope post-discharge and sortout any problems prior to discharge. There is also evidence to suggest that useof PRN or ‘as required' medication decreases when they are easily accessible(according to the speaker at the talk).

As with anyintervention, there are disadvantages. Some drugs are unsuitable forself-administration, for example controlled drugs due to their potential forabuse, or the process may provide patients with too much control and this could lead toother problems. No process or outcome is going to be completely problem-free,though. According to the National Archives[1] a 2002 survey found that 48% ofhospitals had a self-administration scheme in place with a further 15%intending to set one up by the end of 2002 (unfortunately, I couldn't find amore up to date statistic!). Is it time that more trusts allowed patients toself-administer their medication?

Reference:
The National Archives. http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_4898574

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