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Lifting a Regulatory Burden Could Create Dangerous Consequences

Cheryl Clark, for HealthLeaders Media, November 17, 2011

After all, the reasoning goes, the patient brings these medications with him or her into the hospital, why not let him or her take them while they're there instead of making them wait, and letting those drugs go to waste?

Although the comment period ends Dec. 23, objections are already starting to come in.

On the federal website regulations.gov, Stephanie Hutchins, a former hospital nurse who is now a nursing instructor in California, said she is in support of most of the proposed modifications.  "However," she wrote, "I DO NOT SUPPORT allowing the patient or a 'support person' to administer medications to hospital patients.

"Currently studies have shown that 30-50% of patients ignore or otherwise compromise instructions concerning their medication," she wrote. "If a person other than the nurse administers medications in the hospital, the potential for lack of adherence and therefore lack of crucial therapeutic benefit from the prescribed meds in the hospital is high."

Hutchins continued, "if nurses are required to monitor meds given by a person other than the nurse to ensure adherence, it would create a time backlog for the nurse, negating much of the benefit of having them given by another person."

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1 comments on "Lifting a Regulatory Burden Could Create Dangerous Consequences"


Mark Dominesey (11/30/2011 at 8:32 AM)
There clearly two very important sides to this issue. One issue is the patient is trusted to administer the medication (or have someone else administer it for them) while they are out of the hospital, and allowing them to continue that practice can help alleviate some of their anxiety and promote a sense of partial independence. The other issue is that now the hosptal and the clinicians may be required to take responsibility for something that they did not do, or have little control over. The article takes a negative tone for allowing patient administered medications after it does a wonderful job of laying out how clinicians and hospitals can alleviate some culpability. The CMS guidelines appear to be vague enough to allow the hospitals some flexibility in creating policies (in consultation with their Risk Management Dept) that will delineate when this pratice should be allowed and when it should not be. Patient and caregiver education is key to this practice and patient education was not mentioned in the article. Yes, there are very real possibilities of patient harm if certain medications are administered more than what is therapeutically efficacious, but hospitals can craft policies and procedures to mitigate those risks. At no time should patient self-administration be implemented to alleviate some burden on clinicians or for clinician convenience, but only as a vehicle to promote patient independence and wellness. I am in favor of this proposal by CMS. Patient self-administration does occur now, though not widespread, in many hospitals, with a properly [INVALID]d physician order and patient education. Many medications are not suitable for this proposal and it would behoove the hospitals to include such language in their ploicies and procedures along with assistance from their pharmacy staff.