The use of patients own medications provides a number of benefits. This includes;

• Reduced patient confusion by enabling continuity of familiar brands.

• Access to medications that are not stocked by BHS.

• Avoidance of hospital medication wastage for single patient use items such as inhalers and eye drops.

• Reduction in delayed administration of doses

For these reasons, the use of patients own medications is encouraged.

In accordance with national guidelines issued in July 2007, patients own medications may be used during an inpatient stay without breaching the Australian Health Care Agreement, where:

•  the medication is unrelated to the condition for admission; or

•  the medication has been chronically used by the patient, and is required to be continued at the time of admission.

There must be accountability for the storage and return of patient's own medications.

This clinical practice protocol is intended to ensure the appropriate use and safe storage of patient’s own medicines during admission (including patient’s own S8 and S4D medications), and that the use is in accordance with national guidelines. This CPP does not cover self administration of medications by patients.

Patients Own Medication (POMs)
Any medication that a patient has brought with them to hospital that has been dispensed to or purchased by them prior to admission.

Non formulary
A medication that is not stocked by the pharmacy department.

Green 'Patients Own Medication' bags

Tamper Evident Bags (A4 and/or A3)

PROCEDURE

GENERAL ADVICE

• Where possible, patients should be requested to bring in their usual medications for review by the pharmacist. These assist in establishing which medications the patient took at home, and allows the medications to be reviewed for suitability of use during the patients stay. This advice is best given at pre-admission (where applicable).

• The existence of patients' own medications must be established as soon as possible on presentation to a clinical area

• Seek consent to use a patient's own medications throughout their inpatient stay.

• Advise the patient that they must not self administer own medications. If the medications are suitable for in hospital use, they will be administered by nursing staff (approved self medication programs exempted). 

REVIEW

Where a patient has consented to the use of their own medications, examine each medication for suitability of use. Wherever possible this review is undertaken by the pharmacist.

Nursing or medical staff may undertake this review if the medication is required to be administered and;

• it is outside pharmacy hours

• the medication is not available on imprest anywhere in the hospital or in the PFC After Hours Cupboard.

A tablet identification resource (such as MIMS) may be required.

The following considerations are part of the review;

• Patients' own Schedule 8 and Schedule 4D medications should not be used, unless it is a non formulary item. Obtain the consent of the patient to send home their own S8 and S4D medications with a family member or other nominated person.

• Only use medications where the patient's name, drug name, strength and form are clear. Medications packaged in their original bottles may be used if they are consistent with the inpatient order once they have been reviewed by the pharmacist and the contents verified. A Nurse in Charge or Medical Officer may also perform this verification.

• Patients' own inhalers, eye drops, topical therapies, insulin and clinical trial medications may be used.

  • Patients' own liquid medications should not be used unless the hospital pharmacy is unable to supply (e.g. specialised compounded mixtures). Patients' methadone liquid takeaway doses should not be used under any circumstances - please refer to CPP0099 - Methadone Or Buprenorphine As Maintenance Pharmacotherapy for Opioid Dependence - Continuation Of Treatment for Admitted Patients

• Check the expiry date of each product to ensure that the medication has not expired. If the medicine is insulin or an eye/ear drop ascertain that it is either unopened or has been opened within the last month (note that there are a small number of eye drops that have an expiry date greater than a month-seek pharmacist advice).

• Confirm that medications with special storage requirements (e.g. refrigeration, protect from light) have been stored correctly.

• Identify any medications for which there is no order and highlight to medical staff.

• Source any medications that are deemed unsuitable for use (from imprest or by ordering from pharmacy).

Patients' own medications deemed suitable for use do not need to be ordered from pharmacy.

DOSE ADMINISTRATION AIDS (DAAs)

Dose Administration Aids (e.g. Websterpaks, MedicoPaks) provided by the patient at the time of an "After Hours" admission may be used providing that:

• The drug ordered is not available within the hospital.

• The DAA concerned was prepared for the patient by a pharmacy and that a full description of contents is present.

• The drug ordered is able to be identified within the pack. The use of a tablet identification resource, such as MIMS, may be required. Most pharmacy prepared DAA also include a physical description of the tablet/capsule on the pack, which may also be used to identify drugs.

If the medication is still not able to be distinguished from others in the pack, consideration should be given to administering all medications due at that administration time from the DAA (a valid order must exist for all medications). 

Refer to Medication Sources of CPP 0381.

DOCUMENTATION

• Document the verbal consent of the patient/carer to utilise the patient's own medications during their admitted episode. This is to be documented in the patient's progress notes.

• The ward pharmacist or pharmacy technician will endorse the drug chart with 'Patient's own' or 'Pts Own' in the pharmacy section where the use of patient's own medications is intended.  Nursing or medical staff may make a similar note adjacent to the request date section of the chart where patient's own medications are being used prior to pharmacist review. 

STORAGE

Patients' own medications must remain clearly separated from imprest stock at all times. All patients' own medications which are not being used (including S8 and S4D medications) should be stored on the ward or, only if absolutely necessary, in pharmacy. The location of POMs should be documented in the appropriate section of the 'Best Possible Medication History & Reconciliation Form' MR/701.1.

If the patient's own medication does not have a dispensing label attached, affix a patient identification label so that its owner can be identified. Do not remove strips from labelled boxes.

Schedule 8 and Schedule 4D medications

For patients' own Schedule 8 and Schedule 4D medications, sign the medications into the ward's Patients Own S8/S4D Register and then either;

• Obtain the consent of the patient to send home their own S8 and S4D medications with a family member or other nominated person. If this occurs, the details of the person and when they were issued are to be recorded in the Drug Register.

• Store on the ward until discharge (or until the medications are transferred to pharmacy).  Ensure that the medications are clearly labelled to identify the owner. If the medications are stored using BHS approved tamper evident bags (See Appendix One), the bag itself must be accounted for at each shift change. If tamper evident bags are not used, the usual storage and accountability requirements for S8 and S4D medications apply. This includes balance checks at each change of shift, and the necessary recording upon removal from the safe.

Other medications

Place the patient's own medications in the patient's locked bedside drawer, or equivalent storage area.

Any medications that are unsuitable for use should be separated and labelled as such.

The use of green Patient's Own Medication bags is encouraged to avoid confusion with imprest stock. Attach a patient identification label to the green Patient's Own Medication bag. If more than one bag is required, indicate this on the label, e.g. bag 1 of 2, bag 2 of 2.  Adhere to any storage requirements e.g. refrigeration.

TRANSFER AND DISCHARGE

• Ensure that patient's own medications and any individually dispensed items are transferred with the patient to the new ward in a red 'medication transfer bag'. Any S8s or S4Ds must be transferred in a tamper evident bag (TEB) with a page from the sending ward's DD requisition book documenting transfer. This page is then signed by the receiving ward and faxed back to complete the paper trail.

• Ensure the patient's own medications are returned to the patient/carer upon discharge. These must be reviewed (ideally by a pharmacist) to ensure that they are current medications and that the directions are correct. The patient must be advised of any non current medications that are being returned. Any medications for which supply is required should be identified, and supply arranged. Refer to Medications- Patient Discharge and Transfer Process CPP 0434.

• A small number of medications dispensed by the hospital whilst the patient was an inpatient are suitable for the patient to take home (e.g. inhalers, eye drops, creams) if prescribed on discharge. Some items may need to be relabeled before they are suitable for the patient to take home. Please consult the ward pharmacist for guidance for each patient. 

DESTRUCTION

• At all times, patients' own medications remain the property of the patient and cannot be disposed of without patient or carer consent. If return of the medication creates a safety risk to the patient, the treating doctor may authorise that the medications be retained and destroyed by the hospital.

• If medications are to be discarded, ensure this is only carried out with patient/carer's consent. Document consent in the patient's notes and return the medication to pharmacy for destruction, with a note indicating 'for destruction'. Discarding of S8 medications must comply with all legal requirements and, as explained in CPP0496 Medication Security Appendix 3 .

Lost Patient Own Medications

• Where patients' own medications have been lost by the hospital and the patient makes a complaint to the NUM, the medications may be replaced in a sufficient quantity as to avoid inconveniencing the patient. This will only occur after a thorough attempt to locate the medications.

• A prescription must be written for the quantity to be replaced.

• For S4D or S8 medications, the smallest amount required to allow the patient to obtain further supply through their community based care providers (e.g. GP or local pharmacy) is to be issued.

• The medications are dispensed by pharmacy only. Lost patients' own medications are not to be replaced from imprest stock.

•  A VHIMS report will document the events that led to the lost medications.

• All discrepancies will be investigated.