Initiating Self-Administration of Medicines for inpatients with cystic fibrosis.

INTRODUCTION: Children with cystic fibrosis (CF) take a multitude of therapies at home. Self-Administration of Medicines (SAM) is a scheme whereby the parent/carer and/or older child keep control of their own medicines in hospital. We initiated a scheme and assessed drug errors, cost implications, and parent and nurse satisfaction. METHODS: Following a pilot stage, the SAM protocol was initiated and amended as necessary. Drug errors were analysed from the Datix hospital electronic reporting system. Cost analysis of use of the patents own drugs was carried out. Questionnaires were given to parents and nursing staff. RESULTS: In the initial 10 months, 97 children had 159 admissions, and 60% were deemed suitable for SAM. Drug errors still occurred-33 in 5 years. Cost savings for the hospital over 1 year were £20 022 for 123 admissions. Patient/parent satisfaction was high, and all wished to partake in SAM for further admissions. CONCLUSIONS: The scheme was a success although it took 3 years to bring to fruition. Drug errors still occurred but we were able to amend the protocol appropriately to react to these. Cost savings are an incidental benefit from use of patient's own medication. The SAM scheme is applicable to all children with chronic disease on long term medications when they are in hospital.

SELF-ADMINISTRATION OF IN-PATIENT MEDICATIONS: A PILOT STUDY IN CHILDREN WITH CYSTIC FIBROSIS.

INTRODUCTION: Children with Cystic Fibrosis (CF) have complex medication regimens, where responsibility for administration usually lies with the parent/carer until the child is older and able to take over this role.1 On admission to hospital this role is usually undertaken by nurses, leaving patients/parents/carers feeling disempowered, and unprepared for discharge. AIMS: All CF admissions to be offered the Self-Administration Of Medicines Scheme (SAM).▸ Empower patients/parents/carers with responsibility of administering their own medications▸ Reduce nursing time▸ Educate patients/parents/carers about their medications▸ Cost-saving by utilising Patients Own Medicines (PODs). METHOD: A policy and training programme was developed and approved by the Trust's Medicines Management Board. This provided a framework for staff to use so that they may:▸ Obtain consent▸ Evaluate and re-use PODs▸ Safely store and obtain supplies▸ Continuously negotiate accountability for administration with patient/parent/carer.The study was conducted over a 10 month period, where all families with CF admitted, were assessed for participation in SAM. The nursing teams acted as the primary assessors for SAM and any concerns were referred to the paediatric CF multidisciplinary team. To evaluate the pilot, families were given questionnaires to establish their views about the scheme. Nurses were asked to feedback if SAM decreased time for medication administration. To evaluate the associated cost-saving, data on PODs suitable for re-use was collected. RESULTS: 159 children with CF were admitted to the ward, 95 (60%) were assessed to participate in the scheme and 64 (40%) of these did not join. Reasons for not joining included 32 (50%) short admissions, 13 (20%) refused, 5 (8%) patients were seriously ill and 14 (22%) had 'other' reasons. Those who joined the scheme received questionnaires and 31 (33%) of these were completed. All welcomed the scheme and stated that they would take part again with the main benefits cited as not needing to wait for nurses to administer medications, greater independence and the ability to maintain the same routine as home. When asked what participants would change, 16 (52%) stated nothing, 10 (32%) wanted the assessment process to allow for faster progression through the levels of SAM, 4 (13%) asked for larger medication lockers and 1 (3%) wanted better communication about new medications. 30 nursing questionnaires were completed and highlighted that nursing staff spent less time on administering medicines. Nurses also stated that medication administration was less pressurised as double-checking of doses could be performed with the participant, rather than another nurse. Their main concern was the extra documentation required for SAM. Where PODs were used for patients, the average cost saving per patient over a 3 month period was £1023. CONCLUSION: The pilot scheme has been well received by staff and patients/parents/carers, allowing greater engagement in the administration of medicines and cost-savings. As a result of this, the SAM scheme will be extended to the remaining patients on the ward.