Medication Madness.

This post initially featured on Britain's Nurses for STNBC:

Just another pondering from my recent experience at the other end of the stethoscope. A couple of times a day there are the drug rounds: morning, lunch, dinner, bedtime or thereabouts. The nurses go from patient to patient dishing out the drugs that have been prescribed for that time. A system I'm sure works well, most of the time, or at least some of the time. However, what about the patients with multiple long term conditions, those with polypharmacy and a set routine at home? I am great at managing my medication (when I'm not being stubborn), I have a multi-coloured dosette box that I fill at the beginning of the week. It's great. I can identify each of my medications just by looking at it, tell you what I take it for, the dosage, and when it should be taken. So shouldn't we be giving expert patients more autonomy over their "usual" medications even when they're an inpatient?


During my first few days in hospital, I was too poorly to know what time it was, let alone sort out my own medication. Once I began to improve it became apparent that my hospital routine was very different to that at home, and was not allowing my medication to work as well as it usually would for me! For example: domperidone - a drug I take for persistent nausea relating to gastric motility and reflux, is best taken at least 30 minutes before food. I take this medication prior to every single meal. In hospital, domperidone was prescribed on the PRN side of my drug chart, this means I didn't receive it unless I specifically asked for it. So for my first few days I didn't have any domperidone at all, and thus barely ate or threw up what I did tolerate because I wasn't well enough to care/work out what drugs I was and wasn't having. As I got better, I started to ask 30 minutes before mealtimes for my domperidone, but always felt like a burden when it wasn't during a drug round. Another drug I take is ivabradine, which reduces my postural tachycardia. I usually take this when I wake up and at about 3/4pm. My tachycardia is postural, therefore I need the drug most during the daytime - hence not spacing the doses 12 hours apart. In hospital, it was prescribed for 8am and 8pm - meaning between 6am and 8am and from about 4pm my tachycardia and related symptoms were noticeably worse. When I was first admitted, I provided the doctor with a list of my regular and PRN medications, dosages, and when I take them, yet this was not translated onto my drug chart: in fact some drugs were missed off completely. 

It's a difficult issue and I spent a lot of time thinking about it whilst an inpatient. Firstly, there is no single person at fault. The drug charts have specific times that things need to be prescribed, the doctors are busy and writing a drug chart is often the least of their worries, and the nurses are accountable for what's signed for on the drug chart etc. Secondly, I was initially too poorly to contemplate managing my own medication, so that complicated things somewhat. How do we decide if someone is well enough, competent and willing to manage their own meds? Personally, as an expert patient with a long-term condition I feel I would have been far better off managing my own medications once well enough to do so. However, as a healthcare professional I can see that this poses issues in itself. Particularly that if a patient suddenly deteriorates, the nurses won't necessarily know what has and hasn't been taken.  I guess a middle ground would be to give these patient's the autonomy to take their medications as and when they would at home but for them to communicate what they've taken and when, with their nurse so that it can be documented. 

Having mulled this over and over in the past few weeks...I don't know that I'm any clearer than I was...would love to know what my nurse-y type friends think?! 

Comments

  1. I have long term medical conditions that I also take many medications for and the last few times I have been in the hospital it has been the very same for me as well. Luckily they were okay with me managing my own pain medication so that was really helpful because as y ou well know it takes a long time to ask, get a Dr. to okay the RX, then actually wait for the Pharmarcy to dispense it. I noticed your Med Dosette and I have a question for you . Where did you buy it from? I have the same one and I love it, only it is wearing out and I can't remember where I purchased mine from. thank you. I can leave you my email address here and if you happen to recall where you purchased it from please let me know as I have been looking for another as it has been the easiest to fill and keep so far. thanks.

    dolce23girl@gmail.com

    ReplyDelete
  2. I have long term medical conditions that I also take many medications for and the last few times I have been in the hospital it has been the very same for me as well. Luckily they were okay with me managing my own pain medication so that was really helpful because as y ou well know it takes a long time to ask, get a Dr. to okay the RX, then actually wait for the Pharmarcy to dispense it. I noticed your Med Dosette and I have a question for you . Where did you buy it from? I have the same one and I love it, only it is wearing out and I can't remember where I purchased mine from. thank you. I can leave you my email address here and if you happen to recall where you purchased it from please let me know as I have been looking for another as it has been the easiest to fill and keep so far. thanks.

    dolce23girl@gmail.com

    ReplyDelete

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