Self-administration of Patients Own Drugs During Hospital Stay
Self-administration of Patients Own Drugs During Hospital Stay
Background Medication administration errors occur in around 20% of administrations. Patient
 involvement (PI) is recommended and self-management support e.g. as self-administration of
 patient's own drugs during hospital stay is a central component of practising PI.

 Aim To investigate whether PI in administering drugs in hospital affects the number of
 medication errors, medication adherence and patient satisfaction and whether it is
 economically advantageously.

 Materials and methods The PhD Study is performed at the Department of Cardiology, Randers
 Regional Hospital.

 The study design is "complex intervention" and the PhD study therefore consists of three
 studies. In study 1 the intervention is developed, investigated for feasibility and
 pilot-tested in small scale. In study 2 and 3 the intervention is evaluated within a RCT with
 outcomes as medication errors, medication adherence, patient satisfaction and
 cost-effectiveness.
Background When patients are admitted to Danish hospitals, the responsibility for their
 medication is taken over by the hospital staff.

 Medication administration errors occur in approximately 20% of the total opportunities for
 error.

 Patient involvement (PI) is recommended and self-management support is a central component of
 PI aiming to improve patients' knowledge, skills and confidence into managing their health
 condition. "Self-administration of patient's own drugs" during hospital stay is considered a
 central part of self-management support.

 Self-administration of patient's own drugs has been tested in the Capital Region of Denmark.
 Conclusions were that self-administration increase PI, prepare patients to manage their
 medication after discharge and release resources within the care group. The occurrence of
 medication errors compared to traditional medication system was not investigated.

 Aim The aim is to investigate whether PI in administering drugs during hospital stay affects
 the number of medication errors, medication adherence and patient satisfaction and whether it
 is economically advantageously.

 Materials and methods The study design is "complex intervention" and a stepwise process is
 recommended by the UK Medical Research Council. In study 1 the intervention will therefore be
 developed, investigated for feasibility and pilot-tested in small scale. In study 2 and 3 the
 intervention will be evaluated within a RCT.

 Intervention If the patient is assessed able to self-administer own drugs at admission, the
 patient will be asked if he has brought (or can get someone to bring) his usual drugs to
 hospital. The drugs and an updated medication list will be placed in a lockable bedside
 table. During hospitalization the patient is responsible for taking his own medication. If a
 new drug is prescribed, the patient will be involved and instructed about it. Furthermore the
 smallest package will be delivered so that the patient can begin self-administration of the
 new drug during hospitalization. After discharge, the patient can bring the package and an
 updated medication list back home to ensure continuity in the medical treatment.

 Study 1: Feasibility and pilot study The PhD study is performed at the Department of
 Cardiology, Randers Regional Hospital. By visits in the department it is assessed how many
 eligible patients there are, how many patients change ability to self-administer own drugs
 during hospital stay (risk of withdrawal), how many drugs do they receive and how many
 opportunities for error are there? These numbers will be used to assess the inclusion period
 and to calculate the sample size for the RCT. The intervention and workflows will be
 developed in collaboration with nurses, physicians and patients to ensure acceptability,
 feasibility and high patient safety.

 In the pilot study the intervention and tools for study 2 is tested.

 Study 2: RCT The study is a randomized controlled trial where patients are randomized for
 either intervention or control. The intervention group consists of patients who
 self-administer own drugs at home and are able to self-administer own drugs during hospital
 stay. The control group consists of patients who self-administer own drugs at home, who is
 able to self-administer own drugs during hospital stay, but where standard care is used (not
 self-administration).

 Study 3: Health economic evaluation The cost effectiveness of the intervention is assessed
 from the perspectives of the hospital and the health system. Relevant resource use will be
 identified and detailed in study 1 and measured alongside the RCT.

 The costs incurred in the intervention group will be compared to the control group based on
 an intention to treat principle. If the intervention costs in the intervention group exceed
 those in the control group, the costs will be related to an effect measure such as number of
 medication errors avoided.

 Perspectives When the patient plays an active role in their own medication, it is expected
 that they will have a more comprehensive and adequate understanding of their situation and
 will be better to manage their own medication. The number of medication errors during the
 processes of dispensing and administering drugs at the wards is expected to decrease when
 patients administers their own drugs. PI and the use of patient's own drugs during admission
 are expected to contribute to a better utilization of the resources of the Health Care
 System.
Inclusion Criteria:

 -  Patients admitted to the department "Medicinsk sengeafsnit 1", at Randers Regional
 Hospital Monday to Friday from 8.00 am to 6.00 pm

 -  Patients who are self-administering own drugs at home

 Exclusion Criteria:

 -  Patients under 18 years old

 -  Patients who are not able to self-administer own drugs during hospital stay

 -  Patients who do not speak Danish

 -  Patients who can not or will not give informed consent