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Drug round

Administration of drugs 4: by patients

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The final article in this series discusses the advantages and disadvantages of patient self-administration

5 key points

  • Self-administration encourages patients to play an active part in their treatment
  • It requires ongoing nursing assessment of patients’ ability to take their medicines
  • Patients’ ability to take medicines may change while they are in hospital
  • Safe and secure drugs storage is needed
  • Some hospitals aim to increase self-administration by assuming patients can do it if they have taken medicines at home previously. Encouraging patients to administer their own medicines helps to identify their educational needs

M (2011) Administration of drugs 4: by patients. Nursing Times; 107: 37, early online publication.

  • Figures and tables can be seen in the attached print-friendly PDF file of the complete article

Historically, the standard method of medicines administration in healthcare settings, such as hospitals and nursing homes, has involved nurses interpreting a prescription and giving medicine in the required dose via the required route. The patient’s role has been passive.

Self-administration of medicines is based on patients being encouraged to play a central and active part in their drug treatment, just as they would do if at home. The safety and success of self-administration requires ongoing nursing assessment of individual patients’ ability to participate in their prescribed treatment regimens.

This assessment must initially ascertain whether patients administer any prescribed treatment at home, are able to read medicine labels, and can understand dose instructions and open medicine containers or packaging (Box 1). The assessment must also reflect events that take place during the hospital stay.

Box 1. Criteria when assessing patients for self-administration

  • Is the patient receiving medicines and willing to participate?
  • Does the patient appear confused or forgetful?
  • Does the patient have a history of drug or alcohol problems or self-harm?
  • Does the patient self-administer at home?
  • Can the patient read medicine labels?
  • Can the patient open medicine containers?
  • Can the patient open the medicine locker?
  • Does the patient know what their medicines are for, dosage, instructions and side-effects?

For example, a patient judged to be capable of self-administration before surgery is unlikely to be capable in the immediate postoperative period. Such changes in patients’ capability must be reflected in their care plans, and any indications that the ability to self-administer is compromised should trigger a return to nurse-administered treatment.

Self-administration also requires safe and secure arrangements for patients’ medicines and local policies to guide practice (Nursing and midwifery Council, 2008).

Reasons for self-administration

Hospitals are considering the benefits of self-administration for patients and carers for a number of
reasons. There is widespread acknowledgement that traditional methods of medicines administration in hospitals do little to encourage patient concordance. Patients are often discharged with a bewildering bag of medicines that they may have never seen before and may be unsure how to take them.

Encouraging those who are able to administer their own medicines helps staff identify their education needs before they go home and therefore improves treatment concordance.

Making it work

The successful implementation of self-administration systems requires an acknowledgement that traditional drug administration practice does not meet most patients’ needs.

It requires an integrated multidisciplinary approach that focuses on ensuring patients gain the maximum benefit from their medicines.

Despite the strong case for self-administration, its use in acute hospitals remains relatively low. Successful implementation requires commitment from senior nurses, pharmacists and medical staff to support hospital-wide schemes.

Some hospitals are aiming to increase the uptake of self-administration by adopting an “opt-out” approach that assumes patients can self-administer if they have been able to take medicines at home.

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

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