Transcript Developing a Health Promoting Palliative Care Approach

Evaluating the effectiveness of the
‘PATIENTS OWN DRUG SCHEME’ (PODS)
in a Specialist Palliative Care Unit
Presented by
Sue Moran
CNM II Palliative Care Inpatient Unit,
Milford Care Centre, Limerick, Ireland
Milford PODS working group:
Jacqueline Holmes, Liz Mulcahy, Caroline Whiriskey, Marie Wright, Kathy Mc Loughlin
DEFINITION
“The patients own drugs scheme (PODS) is a
system that facilitates patients to bring their
medicines into the palliative care unit for their
own personal use”
H. Lummis et al 2006
Evaluating the effectiveness of the ‘PATIENTS OWN DRUG SCHEME’ (PODS) in a Specialist Palliative Care Unit
Project Objectives
• To review the literature
• To describe the nurse/pharmacist experience
of working/workload within POD’s.
• To describe the medical perspectives
• To identify cost effectiveness of POD’s
• Time Analysis
Evaluating the effectiveness of the ‘PATIENTS OWN DRUG SCHEME’ (PODS) in a Specialist Palliative Care Unit
Project Setting
B
DRUGS TROLLEY
A
DRUGS CABINET
A 30-bedded specialist Palliative Care Unit in Milford Care Centre, Limerick
Evaluating the effectiveness of the ‘PATIENTS OWN DRUG SCHEME’ (PODS) in a Specialist Palliative Care Unit
Patient Participation
Patients
Number
Details
Total Admissions
73
13th January – 30th April 2010
Hospital Admissions
26
No personal medicines
Home Admissions
47
Own medicines
35
No patient refused to
participate during the pilot
period
Suitable Participants
The overall percentage of admission participating
in the PODS was 46.7%
Evaluating the effectiveness of the ‘PATIENTS OWN DRUG SCHEME’ (PODS) in a Specialist Palliative Care Unit
Staff Participation
Discipline
Number
Method of data collection
RGN
15
Consented to participate in
a focus group interview
Pharmacists
2 + Pharmacy technician
Consented to participate in
a focus group interview
Doctors
5
Consented to participate in
a focus group interview
A decision was made not to interview patients at this time as we
anticipated that questions pertinent to patients would emerge from the
above data and would form a second arm of this evaluation to be
completed at a later date.
Evaluating the effectiveness of the ‘PATIENTS OWN DRUG SCHEME’ (PODS) in a Specialist Palliative Care Unit
Key Findings
• Doctors, Nurses and Pharmacists
experience working with PODS
• Time Analysis
• Cost Benefit Analysis
Evaluating the effectiveness of the ‘PATIENTS OWN DRUG SCHEME’ (PODS) in a Specialist Palliative Care Unit
Nurses Experience
 Positively contribute to delivery of patient centred care
 Allows patients to become more familiar with their medication
 Allows for 4 nurses to administer drugs simultaneously
 More timely delivery of medication
 Safe practice - lower potential for drug error as nurses were less
likely to be distracted
 Nurses considered system to be cost effective
 While no direct patient feedback - nurses reported that all patients
were positive re: PODS
Evaluating the effectiveness of the ‘PATIENTS OWN DRUG SCHEME’ (PODS) in a Specialist Palliative Care Unit
Pharmacy Experience
 Improved relationships between nurses and pharmacy
 Improved contact and communication with patient
 Increased opportunity for patients to interact and question pharmacist
 Patient becomes more aware of medication changes
 No delay in obtaining medication from acute service on admission
 Patient safety improved – better medication history
 Provides more information for the team
 Wastage of medication is reduced
 Pharmacy bill has reduced
 Increased interest for staff in starting a new initiative
 Own keys
Evaluating the effectiveness of the ‘PATIENTS OWN DRUG SCHEME’ (PODS) in a Specialist Palliative Care Unit
Doctors Experience
 Medication was not missed as a result of lack of stock
 Less confusion for the patient in the event that a different brand of
medication was used
 Given the proximity of POD’s to patients bed medications could be
visually explained
 If a drug needed to be changed the nurse on the round could
immediately do this
 The doctor could also make changes to drug chart as this was in
the room with the patient
 More efficient use of time with less delays
Evaluating the effectiveness of the ‘PATIENTS OWN DRUG SCHEME’ (PODS) in a Specialist Palliative Care Unit
Time Efficiency
75%
•
By simultaneously administering drugs to their individual patients
drug - round time can be reduced by up to 75%:
•
On Side A, 4 staff nurses administering drugs to their patients
simultaneously, e.g. 3 patients per nurse at 3.68 minutes per
patient implies all 12 patients have their drugs in 11.04 minutes.
•
On Side B, 1 nurse administering drugs, e.g. 12 patients at 3.48
minutes per patients equates all 12 patients have their drugs in
41.76 minutes
Evaluating the effectiveness of the ‘PATIENTS OWN DRUG SCHEME’ (PODS) in a Specialist Palliative Care Unit
Pharmacy Savings
33%
12 patients equates to a cost of €2,193.94.
Evaluating the effectiveness of the ‘PATIENTS OWN DRUG SCHEME’ (PODS) in a Specialist Palliative Care Unit
Recommendations
Present evaluation to Management Team with
recommendation to include Side B in next phase
Suggest that saving accrued through POD’s could be
identified to fund additional pharmacy technician hours
Review location of POD boxes incorporating shelving and
lighting area
Promote ideology of POD’s within the Hospice@Home
Service
To collect further data which will also include patients
views
Evaluating the effectiveness of the ‘PATIENTS OWN DRUG SCHEME’ (PODS) in a Specialist Palliative Care Unit
Conclusion
This simple process was warmly received by the
staff and resulted in immediate savings in both
time and money
“The greatest discovery of any generation is that
human beings can alter their lives by altering the
attitudes of their minds.“
Evaluating the effectiveness of the ‘PATIENTS OWN DRUG SCHEME’ (PODS) in a Specialist Palliative Care Unit
THANK YOU
Many thanks to the
Irish Association of Palliative Care
for inviting us to share this project
Sincere acknowledgement
to Milford POD working group:
Jacqueline Holmes, Liz Mulcahy,
Caroline Whiriskey, Marie Wright
& Kathy Mc Loughlin
Evaluating the effectiveness of the ‘PATIENTS OWN DRUG SCHEME’ (PODS) in a Specialist Palliative Care Unit