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Should hospital patients routinely administer their own medicines?

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25 July, 2011

Would hospital patients benefit if those who were able were allowed to administer their own medicines? What do you think?

Expert comment

Self-administration of medicines schemes allow patients to continue to take their own medicines while in hospital. This maintains their independence and routines and allows health professionals to monitor how they take their medicine and offer advice and support.

However, in acute hospital wards, factors such as short length of stay and dependency of patients means opportunities for assessing patients to self-medicate are limited. As a result, patients who could benefit are overlooked.

In some trusts, models of care are being tried that assume all patients can self-administer their medicines rather than automatically assuming they cannot. It will be interesting to see the results of these “opt out” schemes.

Martin Shepherd, head of medicines management, Chesterfield Royal Hospital NHS Foundation Trust

Readers' comments (25)

  • although I agree that maximum personal autonomy should be retained by individuals in hospital to the extent that it is practical and possible, I just wonder whether on an acute ward with high turn over and short stays there is always sufficient time to adequately monitor patients self adminstration of medication.

    difficulties with the ability to administer their own medicine may be a reason for their hospitalisation.

    I have had patients admitted with all their pills mixed up together, some without their original wrappings, in a plastic bag. Others I have enquired of what medication they are on to be told they have a small white one in the morning, and then another later on which is white with a line across it, and then a pink one at some other time, etc. It wouldn't be the first time that we have had to take a pill with the name of a drug company etched on it to compare it with those in the drug cupboard to identify it but I wouldn't go beyond the more obvious ones such as Aspirin or Lasix for example where they need an immediate dose before being admitted by a doctor as I consider this a highly risky and dangerous practice.

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  • Some patients are very well organised and would prefer to self medicate whist in hospital. They can then take their medication at their normal times, not the times dictated by the routine of the ward (often very delayed!!). Surely it depends upon the patient, and their abilities and motivation?

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  • Why shouldn't patients self medicate? They manage to do it at home.

    It also frees up valuable nursing time to improve upon other areas of care

    It's a no-brainer to me!

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  • We have to remember that the medication prescribed to a patient is their property. I believe it is part of preserving dignity to allow patients to self medicate, if they are able to do so. It obviously depends the condition for which they were admitted and how ill and capable they are. When self administration of medication (SAM) was introduced it was routine to assess patients. Like many other good practices, they get lost along the way. I do also take the point of Anonymous | 26-Jul-2011 2:22 pm. However, it may seem horrific it to us, but that is how many people cope with their medication. To find out your observation, at least the patient was assessed, and there are many strategies to improve compliance. It just goes to show that people take what they are given without question. Whilst the aim is to treat more people in the community and discharge earlier, maybe this is a topic that should be given more attention.

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  • I feel that it is in the pateints best intrest to be able to self administer thier own medication. As in other comments they do it all the time at home, even if we feel that they should not take them like they do ie out of bags or in other pots that is their decision and we can only advice as nurses.
    Thre are many things taht we may not agree on that the patients do but to them this may be there routine.

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  • I agree with patients taking their own medication but not all are able and poor administration or abuse of medication may be a factor which led to their hospitalisation.

    what about the implications of patients making errors when they are under your care? also I would have thought it was our role to try and dissuade them from bad practice such as having a mixed bag of unidentified pills which may be known to them but not to us and therefore difficult to monitor safely.

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  • Another factor I think important is the fact that the reason for being in hospital is for close monitoring. People are not admitted these days for a break or for lightweight reasons so it seems if they're ill then there needs to be a more hands on approach rather than hands off.

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  • What is not mentioned much here is who will get the blame when/if something goes wrong when patients self medicate? I doubt a family will come storming in and put in a complaint against their ailing grandparent! I'm afraid that is all to real a concern in the modern NHS!

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  • I personally think that unless there are concerns over a patients capacity to make decisions then they should always be allowed and encouraged to self medicate. They would then undoubtably get their meds, especially pain relief, when they were needed and not when the nurses decided they should get them.
    Patients sign up to SAM and therefore take responsibility so if there are mistakes and the nursing staff have adhered to local policies then the blame would stay with the patients.

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  • does self medication on wards extend to controlled drugs as well?

    how are drugs belonging to patients who self administer on busy wards kept safe from theft and abuse by others?

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  • I personally think that unless there are concerns over a patients capacity to make decisions then they should always be allowed and encouraged to self medicate. They would then undoubtably get their meds, especially pain relief, when they were needed and not when the nurses decided they should get them.
    Patients sign up to SAM and therefore take responsibility so if there are mistakes and the nursing staff have adhered to local policies then the blame would stay with the patients.

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  • Not so much of a 'no blame' culture going on then?

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  • I would say it is better for patients, who are able, to self administer their own medication. If they are capable of doing this at home why should this be any different in a hospital environment, unless of course their illness indicates to the contrary. I also believe that patients should be encouraged to get dressed each day whilst in hospital rather than wear night clothes, again unless they are acutely unwell.

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  • Anonymous | 28-Jul-2011 10:29 am

    Yes, SAM does include CDs. We have kept medications in locked up cupboards with SAM patients having their own key, as long as that is kept safe by the patient, which is a component of assessment, then their medications are safe. We need to put ourselves in a situation where we may be a patient and this is taken out of our control.

    There are so many medications which don't fit in with hospital drug rounds, e.g. 8 hourly, Parkinson's, before (including a specific time) and during taking food, to name some. We preach compliance, but due to a busy and unpredictable workload, we cannot always fullfil that obligation. We should not assume that all patients are less intelligent or capable than ourselves.

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  • This is at least a 20 year old concept, as is so many other nursing practices lost along the way, then revisited as 'so-called' new ideas!

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  • Self medication by competent patients should be fully embraced. If they are fully able to self medicate at home then although they may lose their dignity, clothing and some autonomy on admission, they do not lose their ability to self care, in most cases. On a recent admission my Mum was informed she was unable to take a medication at her normal 8pm as it did not fit in with the drug round and that it was a medication that is normally administered in the morning. This resulted in her being given a sedative medication at 9am and feeling drowsy and out of it all day. Where is the logic ?

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  • Anonymous | 31-Jul-2011 12:10 pm

    this seems like an example of poor care. why should a patient be sedated all day long as a result?

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  • Anonymous | 30-Jul-2011 0:18 am

    I agree. It seems that if you hang around long enough, perfectly good practice which was thrown out the window and labelled as out-dated, is re-launched as a new idea! 'Intentional Rounding' (what a ridiculous name) being another example.

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  • Anonymous | 31-Jul-2011 3:22 pm

    Anonymous | 30-Jul-2011 0:18 am

    I agree too!

    quite a lot of the useless jargon, management speak and ambivalent abbreviations could be dropped as well so that everybody can understand what is being talked about. SAM and Intentional Rounding indeed! whatever else! Perhaps one might also remember that we are talking about patients and not just targets and outcomes. it is just about as disrespectful as when patients used to be referred to by their bed number and complaint!

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  • I don't think anyone is saying this is new. The question is whether it is possible to do self administration of medicines in a busy acute ward when the assessment process is lengthy. I think the idea of opt out is a good one.

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