"Medication Management"

Multiple medication Management issues whilst in hospital.

1. I take an antihypertensive medication in combination with anti-rejection medication to prevent transplant rejection (a unique but very important indication). This should NOT be ceased unless the risk of hypotension outweighs the risk of transplant rejection. Ceasing this medication has occurred at Bunbury Regional Hospital in the past which reduced my immunosuppression, increased my risk of transplant rejection, and increased my hospital stay length. This impacts hospital costs and my quality of life. To prevent this reoccurring during my last admission I mentioned this to the ED Dr early and expressed the need to think before ceasing it, holding off unless it MUST be stopped. It was ceased the next morning on the Ward and my BP was not too low. Had to request medication not be ceased.

2. HRT not supplied during stay due to the hospital not having it available. My own medications were supplied to staff on admission in a Webster-pak.

3. Transplant anti rejection medication with twice daily dosing was charted as morning and lunch dosing. Webster-pak, normal BD medication administration times, and references all suggest breakfast and bedtime dosing (0800, 2000).

4. Twice daily ADHD stimulant medication, dexamphetamine, should be dosed morning and lunchtime (no later than 1400 to prevent sleep disruption). There was a lot of confusion over doses, dose times, and medication name (it kept getting called dexamethasone). Late dosing caused insomnia overnight. 

5. When Patient's Own Medication was returned on discharge, only the Webster-pak was supplied. Had to specifically request my bottle dexamphetamine be returned too. This is a controlled drug, it is very costly and difficult to replace if it was not returned, or if it had been lost. If it was lost it would need to be reported by the hospital as such, triggering investigation.

Suggested improvements.

1. More structured medication reconciliation, including an interview with the patient/ carer if possible. Should include asking why the patient is taking each medication to produce a Best Possible Medication History. I was not asked until day of discharge about other medications I use such as creams, drops, patches, injections etc. 

2. Using resources supplied, such as the Webster-pak provided, to guide Medication charting, including dose times. This provides detailed information around how the patient usually takes their medication. Use resources to back up intentional changes to medications.

3. Doing everything possible to supply patients with medication i.e. my HRT may not be available on imprest/ pharmacy/ formulary, and you might not be able to source quickly from a community pharmacy, but it was available in the Webster-pak. This medication is also not used for contraception in my case and should not be ceased based on assumption (see above: creating Best Possible Medication History, with patient interviews, and asking why patients take their medication).

4. Better overall communication. 

Disclaimer: I understand hospital is busy, but I believe you have the resources available, and medication management is not an area where corners should seemingly be cut. Although pharmacists are best at completing a medication history, other staff should be completing this when pharmacists are off shift. If I were not in a lucid state where I could advocate for myself, these medication errors wouldn't have been picked up, and would've delayed my hospital stay (as they have already done at Bunbury Regional Hospital during another fairly recent admission). I have been in hospital in not a lucid state before and I write this as I don't want medication mismanagement to occur for myself or others who cannot advocate for themselves, whether that be due to poor literacy or cognitive state.