If you are a patient in the hospital, you may think it makes sense to continue to take whatever medications you were taking before entering the facility. However, it is very important that you discuss with your doctor/nurse what medications you are taking and follow your doctor/nurse’s instructions as to whether or not you should take them while you’re in the hospital. Pennsylvania facilities submitted 879 medication error reports to the Pennsylvania Patient Safety Authority that were caused by patients taking their own medications while in the hospital.
Medications prescribed for and given to patients while they are in the hospital are usually supplied by the hospital’s pharmacy department. However, there are times it may be necessary for a patient to bring his or her own medications into the hospital. For example, patients are often asked to bring their medications with them so that the healthcare provider can see what drugs they are currently taking from home. The “at home” drugs will be checked with whatever medications the patient is prescribed in the hospital to make sure the medications can be taken safely together. Called “medication reconciliation,” this process should occur every time a patient is admitted into the hospital.
Some Challenges for Hospitals with Medication Reconciliation
Hospitals of all sizes face challenges in managing patients’ personal medications. Larger facilities and government hospitals generally maintain a larger inventory of medications and have closed pharmacies. Smaller community hospitals and rural hospitals may not have the space or funds to maintain a large amount of medications and therefore may be more likely to allow patients to use their own medications. The Joint Commission calls on healthcare facilities to follow some guidelines in medication reconciliation. The guidelines include:
- The hospital defines when medications brought into the hospital by patients, their families, or licensed independent practitioners can be given.
- Before using or giving a medication brought into the hospital by a patient, his or her family, or a licensed independent practitioner, the hospital identifies the medication and visually checks the medication for any irregularities.
- The hospital informs the prescriber and patient if the medications brought into the hospital by patients, their families, or licensed independent practitioners are not permitted.
What the Medication Error Reports Show
- Of the 879 medication error reports submitted about patients taking their own medications from home while in the hospital, 77.7% of the events reached the patient and 2.1% of the events resulted in patient harm.
- Almost 300 different medications were mentioned in the reports, and 18.7% (164) of the reports showed that patients took multiple medications.
- More than 25% of the reports mention a medication considered to be a “high-alert” medication. High-alert medications are medications that have an increased risk of causing significant patient harm when they are used in error.
- More than 60% of the reports (534) involved the adult population, while 36.6% (322) involved the elderly. While 2.6% (23) involved children.
- The most medication error event types reported by facilities included: unauthorized drug (48%, 422), other (23.1%, 203), extra dose (8%, 70), and wrong dose/overdosage (2.3%, 20).
- The reports also showed that nearly 8% (70) of the reported events resulted in a transfer of the patient to a higher level of care, with 67% of these cases (47) involving patients taking their own controlled substances.
Why Patients Bring Their Own Medications
Most of the reports submitted to the Authority involved situations where the patient brought in their medications without telling hospital staff and gave the medications to themselves.
Over 12% of reports (111) showed that patients gave themselves their own medications because they were not happy with the care they were receiving. For example, patients either stated that their pain was poorly controlled, they were “tired of waiting” for their medication, or they said that their disease was not being properly treated while in the hospital.
A majority of the reports (44.5%, 391) did not specifically give a reason why the patient took their own medications, while almost 10% (86) of the reports showed some level of miscommunication between the patient and staff.
- Patients were unaware of which medications were prescribed or given to them.
- Patients were unaware that their medications were temporarily stopped.
- Patients were unaware of that the directions for a particular medication were different in the hospital compared to at home.
- Patients were simply unaware that they should not take their own medications while in the hospital.
What You Need to Know as a Patient in the Hospital About Taking Your Own Medications
- The most important thing consumers can do is to maintain an up-to-date medication list.
- Make sure if you are being admitted into the hospital that you share your up-to-date medication list with your doctor/nurse so they know what medications you are on.
- Discuss with your doctor/nurse what medications you will be on while in the hospital and what medications you can take from home (if any).
- If you are uncomfortable with any part of the discussion regarding your medications, make sure you discuss those concerns with your doctor/nurse until you are satisfied with your medication plan while in the hospital.
- During your hospital stay, if you do not feel you are being properly medicated, make sure you discuss your concerns with your doctor/nurse or a nurse manager until you are satisfied.
- Do not take any of your medications from home, unless those medications AND the correct dose have been approved by your doctor/nurse.
- Don’t be afraid to ask questions regarding your medications, especially during your hospital stay. It is important that you/caregiver know details regarding your medication plan especially while in the hospital. Know what medications are being given, why the medications are being given, and how much of the medication should be given each day.
- If you are given permission to take medications from home while in the hospital, make sure you understand the amount of the drug you should be taking each day. It may be different than what you would normally take at home.
For more information about the risks of patients taking their own medications while in the hospital, go to the June 2012 Patient Safety Advisory article, “Patients Taking Their Own Medications While in the Hospital,” at the Authority’s website www.patientsafetyauthority.org.