This project improved the handling of the medications patients bring to hospital, with a review at point of discharge.
By 31 December 2020, 80% of patients who surrender their own medications on admission to St Joseph Hospital will get their own medications checked at the point of discharge from the hospital.
Old process of patient’s own medications (POM) handling at St Joseph’s Hospital was not compliant with the regulatory requirements for handling of patient’s own medications.
Snapshot audit has been done prior to starting the project. The audit showed lack of awareness amongst staff about the correct handling process of POMs.
Interviews of nurses were conducted to asses understanding of POM handling process. The results showed confusion about the way POMs are handled.
- Actively involves patient in their own medications -related decisions on discharge from St Joseph Hospital, which meets the National Safety and Quality Health Service Standard: Partnering with Consumers Standard.1
- Avoids medications confusion and misadventures post discharge, which is one of the major contributing factors to hospital readmission.
- Complies with NSW PD 2013_043 Medication handling in NSW Public health facilities for handling POM.2
- Ensures multidisciplinary approach to patient care.
- Promotes teamwork between disciplines allowing medical team, nursing staff and pharmacists to work together to ensure POMs are checked on discharge.
Plan, do, study, act cycle
- Planning for implementation on pilot wards.
- Discussion around feasibility of implementing the change (POM form versus sticker versus checklist).
- Decision to start small and study the change impact, followed by roll out to other wards.
Figure 1: Nurse interview n=25
Figure 2: Patient’s own medication audit
When patient is admitted to St Joseph’s Hospital wards with their own medications, the POMs need to be handed to the nurses to be stored on the ward. POMs are to be kept in the green patient’s own bag and stored in the ward medications room until patient is discharged.
On discharge, nurse looking after patient needs to hand POMs to the medical team to review if there are any changes in medication regimen. After the check of POMs is completed by resident medical officers, POMs checklist sticker needs to be completed by the nurse and stuck in patient’s progress note.
How to fill in POMs checklist sticker
- If no changes happened to POMs during patient hospital stay at St Joseph’s Hospital, POMs can be returned to the patient. Box for return is ticked and date is written.
- If any changes occur to medication regimen and medications deemed necessary to be discarded in the ward to avoid patient confusion post discharge, POM sticker needs to be completed as follows.
- patient consents to discard his/her own medications, or
- nurse can get verbal authority for discard of POMs and print nurse name and sign, or
- registered medical officer can print name and sign if patient’s or carer’s consent can’t be sought.
Discard box is ticked and date is written and either:
Exemption from following this process
- Patients discharged to aged care facilities.
- Palliative care patients admitted for end of life care.
Multidisciplinary work is continuously needed to encourage patients, when possible, to surrender their POM on admission to hospital and to get them reviewed at the point of their discharge. This can be achieved through:
- Process for the hospital admission liaison nurses
- Adding a summary of POM project into St Joseph’s Hospital admission booklet
- Education sessions for nursing and medical staff
- Follow up meetings
- Cheat sheet
- Nurse’s survey and feedback
- Refresher education sessions and role plays
- Reward program.
Implementation – The project is ready for implementation or is currently being implemented, piloted or tested.
Project start: August 2020.
The project is currently being implemented across all the wards of St Joseph’s Hospital.
Clinical Excellence Commission
- POM project aim has been achieved across all the wards of the hospital.
- All the patients who surrendered their medications on admission to St Joseph Hospital got them reviewed at the point of their discharge from the hospital. Figures 4-10 illustrate the numbers of patients affected across the three wards: Rehabilitation (16), Palliative Care and Rehabilitation Unit - PCARU (11) and Aged Care Psychiatry and Neuroscience Unit - ACPNU (2).
- More than 50% of the reviewed POM on discharge were discarded in the hospital after either consent by the patient, or medical team approval.
- This prevented possible medications misadventure post discharge.
On the Rehab ward from 4 August 2020 to 31 December 2020 (figures 4 and 5):
- 82 people were discharged
- 16 people had POMs on discharge
- 16 POMs were reviewed at discharge
- 9 POMs were returned
- 7 were discarded due to changes.
Figure 4: Review of POMs on discharge in Rehab ward 04/08/2020 - 31/12/2020
Figure 5: POMs new handling process in Rehab ward 04/08/2020 - 31/12/2020
On the PCARU ward from 21 September 2020 to 31 December 2020 (figures 6 and 7):
- 27 people were discharged
- 11 had POMs on discharge
- All POMs were reviewed at discharge
- 7 POMs were returned
- 4 POMs were discarded due to changes.
Figure 6: Review of POMs on discharge in PCARU ward 21/09/2020 - 31/12/2020
Figure 7: POMs new handling process in PCARU ward, 21/09/2020 - 31/12/2020
On the ACPNU ward from 2 November 2020 to 31 December 2020 (figures 8 and 9):
- 5 people were discharged
- 2 had POMs on discharge
- 2 POMs were reviewed at discharge
- 1 POMs were returned
- 1 POMs were discarded due to changes.
Figure 8: Review of POMs on discharge in ACPNU ward, 02/11/2020 - 31/12/2020
Figure 9: POMs new handling process in ACPNU ward, 02/11/2020 - 31/12/2020
Figure 10: Compliance
- Review of patient’s own medications on discharge avoids possible hospital readmissions due to potential medications misadventure post discharge.
- Involving patients in their own medications-related decisions ensures safe medication management.
- Australian Commission on Safety and Quality in Health Care. National Safety and Quality Health Service Standard: Partnering with Consumers Standard. Sydney: ACSQHC. Available from: https://www.safetyandquality.gov.au/standards/nsqhs-standards/partnering-consumers-standard
- NSW Ministry of Health. Medication handling in NSW Public health facilities. PD 2013_043. Sydney: NSW Ministry of Health; 2013. Available from: https://www1.health.nsw.gov.au/pds/Pages/doc.aspx?dn=PD2013_043
St Joseph Hospital
St Vincent’s Health Network
Phone: 02 9749 0311