Inpatient self-administered medication under the supervision of a multidisciplinary team: a randomized, controlled, blinded parallel trial
Background: Self-administered medication (SAM) is encouraged in many hospitals worldwide as it increases patients’ knowledge and understanding of their medication, but the effects on other outcomes, e.g. compliance or medication errors, were unclear.
Objectives: To compare medication knowledge, adherence, medication errors, and hospital readmission among inpatients receiving SAM education under the supervision of a multidisciplinary team (study group) with those receiving routine nurse-administered medication (control group).
Methods: This study was a PROBE design. Inpatients with chronic diseases were randomly allocated (1:1) to either the study group or the control group using stratified-block randomization. Knowledge of medications was measured at hospital discharge and at the first two follow-up visits; adherence was measured at the first two follow-up visits, medication errors while in hospital, and hospital readmission within 60 days after discharge. For normally distributed continuous outcomes, mean difference and 95%CI were estimated; otherwise the median and the Mann-Whitney test p-value were reported. The percentage difference and 95%CI were reported for binary outcomes.
Results: 70 patients were randomized (35 in each group); all received complete follow-up. Both groups were similar at baseline. Mean (SD) age (years) were 59.2 (11.0) for the study group and 58.3 (12.0) for the control group. Percentages of females in the respective groups were 54.3 and 60.0. Mean time from discharge to the first follow-up visit was two weeks in both groups and time to the second follow-up visit were 68.8 days (study group) and 55.0 days (control group). The study group had significantly higher medication knowledge than the control group at hospital discharge (of the 10-point scale, medians, 8.56 and 6.18, respectively, p<0.001). The corresponding figures were similar in both groups at the first follow-up visit (medians, 8.25 and 6.26, respectively, p<0.001). Adherence to medication at the first visit in the study group (percentage mean 92.50% (SD=5.33%)) was significantly higher than that in the control group (79.60% (SD=5.96%)), percentage mean difference 12.90%, [95%CI 10.20%:15.60%], p<0.001. Medication knowledge and adherence were sustained at the second follow-up visit. During hospitalization, no medication errors were found in the study group, and minimal errors occurred in the control group (1.48%, [95%CI 0.68%:2.28%] of doses administered, p=0.001). Hospital readmission within 60 days after discharge was significantly lower in the study group (11.4%) than that in the control group (31.4%), percentage difference 20.0% (95%CI 1.4%:38.6%), 1-side Fisher exact p=0.039.
Conclusions: Among in-patients with chronic diseases, SAM program significantly increased knowledge of and adherence to prescribed medications. Medication errors regarding administration errors were infrequent but significantly higher in the control group. SAM reduced hospital readmission within 60 after discharge.
Wongsuwansiri S. Nursing standards for in-patient care. In: Jirasinthipok T, Jermviwatkul P, Nidtayangkul S, Wongsuwansiri S, Wongjaroen S, editors. The nursing standard in hospital. Bangkok: The War Veterans Organization of Thailand, 2008.
Formby FT. Medication self-administration by patients: a way to prevent errors? Med J Aust. 2008;189(8):471. https://doi.org/10.5694/j.1326-5377.2008.tb02132.x
Furlong S. Do programmes of medicine self-administration enhance patient knowledge, compliance and satisfaction? J Adv Nurs. 1996;23(6):1254-1262. https://doi.org/10.1046/j.1365-2648.1996.11925.x
Garfield S, Bell H, Nathan C, Randall S, Husson F, Boucher C, Taylor A, Lloyd J, Backhouse A, Ritchie L, Franklin BD. A quality improvement project to increase self-administration of medicines in an acute hospital. Int J Qual Health Care. 2018;30(5):396-407. https://doi.org/10.1093/intqhc/mzy035
Jensen L. Self-administered cardiac medication program evaluation. Can J Cardiovasc Nurs. 2003;13(2):35-44.
Palese A, Achil I. Self administration of oral medications in hospitalized patients with orthopedic-traumatology conditions. Assist Inferm Ric. 2003;22(4):210-215.
Vanwesemael T, Van RB, Petrovic M, Boussery K, Dilles T. SelfMED: Self-Administration of Medication in Hospital: A Prevalence Study in Flanders, Belgium. J Nurs Scholarsh. 2017;49(3):277-285. https://doi.org/10.1111/jnu.12290
Wright J, Emerson A, Stephens M, Lennan E. Hospital inpatient self-administration of medicine programmes: a critical literature review. Pharm World Sci. 2006;28(3):140-151. https://doi.org/10.1007/s11096-006-9014-x
Kitpaiboontawee S. Pharmaceutical care in general medical ward at middle-level hospital. Region 11 Med J. 2017;31:369-383. Available at: https://www.tci-thaijo.org/index.php/Reg11MedJ/article/view/170364/122450 (accessed Feb 15, 2018).
Chayanattapong P. [Drug related problems in patients with chronic diseases during home visits by pharmacists in the family care team of Promkiri district health network]. Thai J Pharm Pract. 2017;9(1):103-110.
Hancock B. Self-administration of medicines. Br J Nurs. 1994;3(19):996-999. https://doi.org/10.12968/bjon.19188.8.131.526
Rycroft-Malone J, Latter S, Yerrell P, Shaw D. Nursing and medication education. Nurs Stand. 2000;14(50):35-39. https://doi.org/10.7748/ns2000.08.14.50.35.c2910
Alibhai SM, Han RK, Naglie G. Medication education of acutely hospitalized older patients. J Gen Intern Med. 1999;14(10):610-616. https://doi.org/10.1046/j.1525-1497.1999.11038.x
Calabrese AT, Cholka K, Lenhart SE, McCarty B, Zewe G, Sunseri D, Roberts M, Kapoor W. Pharmacist involvement in a multidisciplinary inpatient medication education program. Am J Health Syst Pharm. 2003;60(10):1012-1018. https://doi.org/10.1093/ajhp/60.10.1012
Grantham G, McMillan V, Dunn SV, Gassner LA, Woodcock P. Patient self-medication--a change in hospital practice. J Clin Nurs. 2006;15(8):962-970. https://doi.org/10.1111/j.1365-2702.2006.01398.x
Collingsworth S, Gould D, Wainwright SP. Patient self-administration of medication: a review of the literature. Int J Nurs Stud. 1997;34(4):256-269. https://doi.org/10.1016/s0020-7489(97)00013-8
National Statistical Office, Ministry of Digital Economy and Society, Report on the 2017 survey of the older persons in Thailand, Bangkok: National Statistical Office; 2018.
Panel on Ageing and Social Development. Social development and ageing: crisis or opportunity? Geneva: WHO. 2000. Available at: http://www.who.int/ageing/publications/development/alc_social_development.pdf (accessed Apr 24, 2018).
Richardson SJ, Brooks HL, Bramley G, Coleman JJ. Evaluating the effectiveness of self-administration of medication (SAM) schemes in the hospital setting: a systematic review of the literature. PLoS One. 2014;9(12):e113912. https://doi.org/10.1371/journal.pone.0113912
National Coordinating Council for Medication Error Reporting and Prevention. Types of Medication Errors. National Coordinating Council for Medication Error Reporting and Prevention. 2018. 2018. New York. 3-1-2018. Available at: https://www.nccmerp.org/types-medication-errors (accessed June 2, 2018).
Lam P, Elliott RA, George J. Impact of a self-administration of medications programme on elderly inpatients' competence to manage medications: a pilot study. J Clin Pharm Ther. 2011;36(1):80-86. https://doi.org/10.1111/j.1365-2710.2009.01157.x
Lowe CJ, Raynor DK, Courtney EA, Purvis J, Teale C. Effects of self medication programme on knowledge of drugs and compliance with treatment in elderly patients. BMJ. 1995;310(6989):1229-1231. https://doi.org/10.1136/bmj.310.6989.1229
Pereles L, Romonko L, Murzyn T, Hogan D, Silvius J, Stokes E, Long S, Fung T. Evaluation of a self-medication program. J Am Geriatr Soc. 1996;44(2):161-165. https://doi.org/10.1111/j.1532-5415.1996.tb02433.x
Phelan G, Kramer EJ, Grieco AJ, Glassman KS. Self-administration of medication by patients and family members during hospitalization. Patient Educ Couns. 1996;27(1):103-112. https://doi.org/10.1016/0738-3991(95)00794-6
Humphries C, Al Hashemi S. Pioneering a medication self-administration program in a tertiary hospital rehabilitation ward. Innovation in Aging. 2017;1(suppl 1):220. http://doi.org/10.1093/geroni/igx004.824
McLeod M, Ahmed Z, Barber N, Franklin BD. A national survey of inpatient medication systems in English NHS hospitals. BMC Health Serv Res. 2014;14:93. http://doi.org/10.1186/1472-6963-14-93
Vanwesemael T, Dilles T, Van Rompaey B, Boussery K. An Evidence-Based Procedure for Self-Management of Medication in Hospital: Development and Validation of the SelfMED Procedure. Pharmacy (Basel). 2018;6(3):77.
The Society of Hospital Pharmacists of Australia Committee of Speciality Practice in Rehabilitation and Aged Care. SHPA Guidelines for Self-Administration of Medication in Hospitals and Residential Care Facilities. J Pharm Pract Res. 2002;32(4):324-325. https://doi.org/10.1002/jppr2002324324
Svensk J, McIntyre SE. Using QR code technology to reduce self-administered medication errors. J Pharm Pract. 2019 [Epub ahead of print]. http://doi.org/10.1177/0897190019885245
Bubalo J, Warden BA, Wiegel JJ, Nishida T, Handel E, Svoboda LM, Nguyen L, Edillo PN. Does applying technology throughout the medication use process improve patient safety with antineoplastics?. J Oncol Pharm Pract 2014;20(6):445-60. http://doi.org/10.1177/1078155213514469
Manias E, Beanland C, Riley R, Baker L. Self-administration of medication in hospital: patients' perspectives. J Adv Nurs. 2004;46(2):194-203. https://doi.org/10.1111/j.1365-2648.2003.02979.x
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