There is a lack of information about patient satisfaction with bedside storage of drugs. Researchers evaluated inpatients’ experiences of a new medicines service
NHS Greater Glasgow and Clyde’s Making the Most of Your Medicines service involves a more patient-centred approach to inpatient medication administration. A study explored patients’ knowledge, experiences and views of the service.
Citation: Lindsay G et al (2014) Inpatients’ attitudes to a personalised drug service. Nursing Times; 110: 36, 20-22.
Authors: Grace Lindsay is reader in clinical nursing research (joint appointment) NHS Greater Glasgow and Clyde/Glasgow Caledonian University, School of Health and Life Sciences, Glasgow Caledonian University; Teresa Crawford is research assistant, School of Health and Life Sciences, Glasgow Caledonian University and NHS Greater Glasgow and Clyde; Carl Fenelon is clinical pharmacist; John Stuart is head of nursing, regional services; both at NHS Greater Glasgow and Clyde.
- This article has been double-blind peer reviewed
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In 2002, NHS Greater Glasgow and Clyde introduced the Making the Most of Your Medicines service. This was in response to the Right Medicine strategy (Scottish Executive Health Department, 2002). This emphasised the need for a modernised, patient-centred partnership approach, with pharmacists working with healthcare teams and patients, to ensure medicine administration systems are as effective and safe as possible. Within acute adult hospital care this includes the use of patients’ own drugs (PODs) if suitable during their hospital stay, and the supply of individually labelled medicines, which can be used to provide patients’ discharge medicines at ward level.
The aim of the service is to eliminate waste by using PODs, reduce patients’ exposure to risk by removing unsuitable PODs, and reduce waiting times for discharge prescriptions to be dispensed from hospital pharmacies. Another medium to long-term aim of the strategy is to move towards self-administration of medication by inpatients where appropriate.
How the new service works
The Making the Most of your Medicines service delivers PODs to the ward. These are checked and administered from the patient’s individual locked bedside medicine cabinet. The patient’s primary registered nurse administers the medicines observing the Nursing and Midwifery Council’s (2007) medicines management standards.
Standard operating procedures are in place including: gaining patient consent to assess PODs; using and disposing of PODs; stocking medicine lockers; and ordering non-stock medicines.
Focus groups with 10 registered nurses and four registered midwives from three wards explored their views of the new medicines service. Three focus groups were held: one on an orthopaedic ward (n=5); one on a neurosurgical ward (n=5); and one on a maternity ward (n=4).
Nurses acknowledged the benefits of the service, such as not having to stock unnecessary drugs and quicker patient discharge. However, some thought the new system increased workloads. While there is clinical and technical pharmacy support, nurses are more involved in checking PODs, stocking medicine lockers and assembling discharge medications. Participants also identified a need for training in assessing PODs and assembling discharge medications, for clarity of responsibility and for procedures such as dealing with discontinued medications at ward level.
Further study was recommended in these areas to understand how inpatients feel about the medicines service.
The primary aim was to explore patients’ knowledge, experiences and views of the medicines service in adult acute inpatient wards where the system was established. We also aimed to determine whether patients had a preference for the medicines service or the conventional drug trolley.
Ethical approval was not considered necessary as this was a service review. No patient data was identified and anonymity and confidentiality for voluntary participation in the interview was assured.
There is sparse information about patient satisfaction or experience with bedside storage of their medications.
A Canadian study in an acute hospital explored the efficiency and safety of a locked bedside medicine cupboard compared with the conventional trolley (Bennett et al, 2006). This qualitative and quantitative study was conducted in two 24-bed acute medical wards. Its findings support decentralised medication delivery systems for both patient and nurse satisfaction, because nurses check medication in patients’ rooms (rather than in hallways), which enables more nurse-patient time. Patient teaching is easier to undertake in a more private environment at the bedside, which may facilitate personalised discussion about specific medications.
A study in a rehabilitation setting within NHS Lothian explored patients’ opinions pre- and post-implementation of a system similar to Making the Most of Your Medicines (referred to as one-stop dispensing) and a self-medication scheme (Gibson and Rankine, 2006). Most patients were more satisfied with their new bedside medicine lockers (86%), using their own PODs (73%) and being able to ask more questions when nurses administered their medications from the bedside medicine locker (71%).
Where self-administration of medications is concerned, Manias et al (2004) found patients who self-administered were generally more satisfied with their overall care and the discharge process compared with those who did not self-administer.
A review in England of patients’ views about the process of administration of medicines in the acute mental health setting (Duxbury et al, 2009) found patients valued having things explained and having their opinion sought. They wanted better information and communication, and a less regimented and more individualised medications administration system. This is not surprising given the outdated practice of mental health patients queuing for their medications.
While there are clear differences in the clinical environments and dynamics between acute mental health and acute general care, what these patients wanted and valued are what the Standards for Medicines Management (NMC, 2007) and the NMC code of conduct (NMC, 2008) describe. These require nurses to treat patients as individuals, collaborate with those in their care, provide information and education about medications, and understand their effectiveness and side-effects.
A semi-structured patient questionnaire was used as a guide to interview a convenience sample of patients in seven medical inpatient wards where the medicine service was established. Staff identified patients who should not be approached on clinical grounds. A total of 41 patients were invited to be interviewed and 40 (98%) consented. Participant responses were transcribed. The interviewer was a registered nurse independent of the project.
The bedside medicine cabinets in use were either a metal white locker top (WLT) (Fig 1) or an integrated locker (IL) type (Fig 2). The WLT was positioned on the top front surface of the locker, occupying one third of the surface; the IL was integrated within half of the upper section of the locker. Both were locked and the master keys were held by the registered nurse. Both systems reduced the locker space available to patients for their belongings. Most were emergency admissions. While only seven participants were aware of the service, 15 of the 37 participants who were on medications pre-admission brought some or all of their medications.
A thematic analysis of interview notes was used to identify the key themes. Our quantitative findings are presented in Table 1, and the qualitative findings are presented as quotes and themes.
Previous experience of drug trolleys
A total of 37 participants had previous experience of the drug trolley system; only two preferred the trolley. One, an ex-NHS employee, felt the trolley was “tidier” and the other felt the new system was a “hindrance”, because his chair had to be moved to access the locker. Overall, 32 participants, including three who had no trolley experience, expressed a preference for the new service with six having no preference. Participants preferred the service for three main reasons, “safety”, “security” and “it was better for staff”.
Seventeen participants felt the new system was safer for patients because it should reduce medication mistakes. They were more confident that only their drugs were in their own medicine cabinet:
“This is much better they’re not hunting about the trolley… you know the medicines are yours… works really well.”
“It’s very clever, the old trolley had too many drugs and they all looked the same.”
Seven participants felt the system was more secure from theft, and other patients:
“No one else can get at it.”
“It’s much better under lock and key… think it’s great, the old system was open to theft.”
Advantages for nursing staff
Seven participants perceived the new system as better for nursing staff. This was because they felt nurses would not make mistakes and it reduced their workload by eliminating trips to the drug trolley:
“New system is more ideal for nurses as tablets don’t get mixed up.”
Seven participants disliked the position of the medicine locker and lack of locker space for their possessions. Both types of medicine cabinets reduced the locker space available to patients. If patients are seated in front of their bedside lockers, they must move or be moved to allow the nurses access.
One participant was concerned he could not open the drug locker and said he would prefer to have the key. Another felt it was not very secure and could be broken into, but added that nor was the trolley.
Six participants identified that tablets were often not in the locker and that staff went to other lockers or cupboards to get them. Two identified previous delayed discharges with the medicine service, when new drugs were prescribed pre-discharge.
Five participants said they would prefer to have the WLT cabinet relocated. Two said they would prefer to have the key and take their own medications; one of these also felt nurses should be allowed to borrow drugs from other lockers.
One participant said she would prefer her name on the locker top cabinet. She was concerned that if lockers were moved and her locker was changed with another, then there may be the possibility of being given the wrong medication. One participant suggested emphasising the need to bring in medications with notices in GP surgeries.
This evaluation provides an opportunity to embed patients’ views in the wider implementation of this new system. Participants were happier that their own medications were safe and secure beside them.
It is reassuring that participants’ experiences and views of the service were largely positive. The only negative aspect was the reduced locker space. The interviewer observed nurses getting drugs from both types of lockers and neither appeared ideal. Patients and furniture required moving, nurses had to bend to access the ILs and, with both locker types, staff had limited surface space to align the drug chart to check and sign medications. Some nurses continued to use the drug trolley as a work surface to place the drug chart. No other comparative studies were found that identified similar logistical problems accessing the bedside lockers.
The most positive aspect for patients is the new service is viewed as safer, in that they feel fewer mistakes can be made. Better security for medications was also a perceived positive feature for seven participants. Emphasis is placed in standard operating procedures and NMC (2007) standards for medicines management that PODs, including controlled drugs, remain patients’ property and must not be removed without their permission.
Despite the space and stocking issues, most participants (32 out of 34) who expressed a preference between the conventional drug trolley and medicines service, preferred the latter. It would be beneficial to patients and staff to source a more appropriate combined personal and drug bedside locker for future use. For example, a combined personal locker and medicine cabinet system that would allow the bedside locker to be moved with the patient if required. Future self-administration would be enabled with patients holding a key or swipe card.
The majority of participants preferred the medicine service to the conventional drug trolley. The only reservations and dislikes were the reduced space they had on top of or inside their bedside locker owing to the location of their medicine cabinet.
Further work should be undertaken in respect of nursing workload. Patient satisfaction with the service should continue to be part of the monitoring process. Patients’ views on future self-medication in hospital should be sought, including their understanding of the purpose of self-medication and possible decisions they may be faced with. It would also be beneficial to patients and staff to source more appropriate separate or combined personal and drug bedside lockers for future use.
- The Right Medicine Strategy in Scotland aims to ensure patients’ medications are managed as safely and effectively as possible
- Greater Glasgow Health Board introduced the service in 2002
- Research shows patients value more personalised medication administration systems
- The majority of adult inpatients prefer their drugs to be stored in a bedside locker rather than on a drug trolley
- Patients may lose bedside storage space if lockers are used, and they may be difficult to access
Bennett J et al (2006) Improving medication administration systems: an evaluation study. Canadian Nurse; 102: 8, 35-39.
Duxbury J et al (2009) A study of the views of patients and nurses about the administration of medication in the acute mental health setting. Journal of Psychiatric & Mental Health Nursing; 16: 7, 672-677.
Gibson P, Rankine E (2006) Redesign of medicine supply system in a rehabilitation hospital. Nursing Standard; 20: 31, 48-53.
Manias E et al (2004) Self-administration of medications in hospital; patients’ perspectives. Journal of Advanced Nursing; 26: 2, 194-203.
Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives
Nursing and Midwifery Council (2007) Standards for Medicines Management. London: NMC.
Scottish Executive Health Department (2002) The Right Medicine: a Strategy for Pharmaceutical Care in Scotland. Edinburgh: Scottish Executive.