A research study in Northern Ireland looks at how to improve continuity of care and reduce drug expenditure in a hospice setting. Stephen Ward, Teacher Practitioner Pharmacist in the Belfast Trust, Northern Ireland, UK, explains the background to his longer article published in the January/February issue of the European Journal of Palliative Care.
In the Northern Ireland Hospice, like many healthcare settings, increasing demands on nursing staff and the need to reduce risks have driven a search for increased efficiency and accuracy in the medicines management process. We are fortunate to have staff who share their role both in the hospice and the hospital setting. This allows us to review best practice within each setting and assess what process can be transferred with a potential benefit to patient care.
In UK hospitals, the National Health Service (NHS) encourages the use of patients’ own drugs (PODs) administered directly from bedside lockers. A PODs scheme has several advantages: asking patients to bring their own drugs to the hospital improves the accuracy of the medication history record on admission; the patient continues to receive drugs with which they are familiar; the scheme leads to drug expenditure savings for the hospital; and it prevents potential dose omissions that might occur if a medicine is not stocked at the hospital when the patient is admitted.
Bedside lockers also have potential benefits. The fact that nurses do not have to move around the ward with a medicine trolley can save time, as it reduces interruptions from other staff, patients or families during administration rounds. The problem we encountered is that so far, there is little evidence supporting this process in a hospice setting.
The different setting is an important consideration. Hospice patients tend to rely more on controlled drugs such as opioids. For a number of reasons described in our paper their inclusion in a bedside locker system is impractical. Also, many hospice patients encounter swallowing difficulties requiring liquid medicines. For expiry and storage purposes these preparations are also not ideal for the POD locker scheme.
With this in mind, we set out evaluating how such a process would impact on how we manage medicines in a hospice setting. We compared our traditional medicine trolley system with a POD locker scheme over two separate periods in the hospice. We looked at the following outcomes:
- Nursing time for drug administration
- Cost of inpatient medicines
- Cost of discharge medicines
- Omitted doses because drug was not available.
We found that following the introduction of the POD locker scheme in our hospice the time taken for daily medicine administration across the unit was reduced by an average of two hours four minutes each day. There was a 16% reduction in the cost of inpatient medicines. The cost of discharge medicines decreased from £125 to £94 per patient. The amount of doses missed because a drug was not available was reduced from 1.25% to 0.75% of all doses administered.
Based on this study we believe that a PODs locker scheme has the potential to produce benefits in a hospice setting, despite the fact that palliative care patients require drugs that cannot be managed as part of such a scheme.
Read a copy of the full article in the European Journal of Palliative Care
This post relates to a longer article, ‘Patients’ own drugs and bedside lockers: can they be of benefit in hospices?’ by Stephen Ward, Max Watson and Clare White, published in the January/February 2015 issue of the European Journal of Palliative Care (vol. 22.1).
If you have a web-based subscription to the journal you’ll be able to download this issue, plus all articles in the journal archive. You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journal – click here to subscribe online.
Are you coming to Copenhagen?
See you at the 14th World Congress of the European Association for Palliative Care – Copenhagen, Denmark, 8-10 May, 2015. Follow us on Twitter @EAPCOnlus – our official congress hashtag is #eapc2015
Kommer du til København?
Vi ses på the 14th World Congress of the European Association for Palliative Care i København, Danmark, den 8-10 maj, 2015. Du kan følge med på Twitter @EAPCOnlus – vores officielle kongres hashtag er #eapc2015