Hospital Pharmacist
Vol 9 No 5 p124
May 2002

Letters (One-stop dispensing, patients’ own drugs and self-administration )

From Mr J. Beard

Re: "Guidelines on one stop dispensing, use of patients' own drugs (PODs) and self-administration" (PDF* 80K) (Hosp Pharm, March 2002, pp81–6).

I read the above article with interest. It is clear and concise, and presents a brief discussion on the implementation of 28-day supply, one- stop dispensing and patient self-medication, in line with current recommendations.

Having been closely involved with the implementation and maintenance of such schemes between 1996 and 2000, I appreciate the associated problems. I believe that the article did not sufficiently address the issues surrounding required staffing levels, nor emphasise the need for different grades of staff to run such ward-based schemes. The issue of training is probably the biggest obstacle to safe practice as it involves an almost complete change in working practices for nursing staff, and the development and maintenance of new roles for pharmacy staff on wards. I suspect many pharmacy departments are currently unlikely to have sufficient staffing resources to implement such services. There is also no "fall back" position with one-stop dispensing when staffing levels are acutely reduced. It is also a system that is best served where there is a pharmacy service seven days a week.

Our department has reviewed its current ability to implement and maintain the above systems. We feel that our current pharmacist and technician staffing levels are inadequate to the task. However, we appreciate the need to improve discharge procedures.

Currently, we are piloting a patient discharge system which allows for the use of PODs, reduces the dispensing error rate, reduces the workload presented to the dispensary, enhances aspects of patient education and speeds patient discharge over the current system. It is as follows:

1. Admissions pharmacists and ward pharmacists check drug histories and then identify whether the patient has sufficient supplies of PODs for discharge. These PODs are either brought into hospital at the time of admission or they are reported by the patient to be at home. PODs are identified as such on the administration chart. The purpose of this is explained to the patient during the counselling session at the bed-side.

2. At the time of discharge, the administration chart is brought to the pharmacy for checking along with the discharge letter. PODs data are transferred onto the discharge letter..

3. A summary of the entire patient drug history is produced for the patient, while only those drugs that are unavailable to the patient are dispensed.

4. The patient is then discharged with only the newly prescribed medicines and a summary of their current drug regime for their reference.

This is a procedure that will not be unfamiliar to many pharmacists, who, faced with drug unavailability or the need for "immediate" discharge will have ascertained what the patient actually needed and supplied only that.

I have discussed the process with several clinical pharmacy managers from the West Country and the main criticism is that we are unable to ascertain the suitability for reuse of PODs that are at the patient's home. The counter to this is that we send the patient home to these medicines anyway, often with duplicate supplies and with no patient specific instructions on which medicines to take and which not to take. We feel that this pilot discharge procedure is a reasonable interim system to operate in light of our staffing levels. It requires significantly less training than those systems discussed in the above article and has a workable fall back position, ie, that which is currently operated. It may also be of interest that we have demonstrated a real ward drug budget saving (between £10–14 per patient discharged from three general medical wards).

We would welcome constructive comment on our pilot scheme.

Jon Beard
Principal Pharmacist
Taunton and Somerset Hospital

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