Self administration: a patient-centred approach to administering time critical Parkinson’s medication at University Hospitals of Leicester NHS Trust: best practice case study

What is your role in self administration at UHL?

We're part of the medicines safety team that retains overall governance for the self administration of medicines process, from maintaining the policy, to supporting wards and patients in the hospital.

Left to right: Joanne Mee, Medicines Management Nurse; Imogen Sutherland, Medicines Safety Pharmacy Technician; Hannah Flint, Senior Nurse.

What are the benefits of self administration for the patient?

• Patients are empowered because they have more control and independence in administering their medication. 
• It also allows those medications that are time critical, such as Parkinson’s medication, to be self administered in line with a patient’s usual regime. It provides true patient-centred care leading to improved patient satisfaction. 
• The patient’s knowledge and awareness of their medication is increased through individual education, training and assessment.

What are the benefits of self administration for the hospital and staff?

This is about improving the patient experience and, ultimately, that should improve job satisfaction. The trust can promote itself as one that offers self administration to patients.

Self administration can also reduce medication wastage, dispensing and costs.

How did your trust develop your self administration policy?

The policy has been in place since 2004. It was successfully rolled out within the renal areas, thanks to our committed pharmacy and nursing teams. In 2015, the medicines management team started to expand. The drivers to roll the policy out more widely were this expansion and the trust's appetite to improve the patient experience through self administration, specifically insulin at the time.

The trust requires policies to be reviewed every 3 years, but this can be, and is, done more frequently when developments are needed or practice dictates a change. We are currently on version 8!

As the trust transitions to electronic patient records, the paper assessment tool has been replaced with an electronic version. The electronic system allows the medicines management team to maintain an overview of those patients who've been assessed to self administer.

Feedback from staff is that the electronic version is an easier and more efficient way to assess. It also prompts staff to reassess when necessary.

What is the aim of the policy?

The policy aims to provide a governance framework to allow patients over 16 and parents, guardians and carers (for those patients under the age of 16 years), to be assessed to self administer their medication.

The policy allows the assessment to be done by registered nurses, registered nurse associates, registered midwives, pharmacists and pharmacy technicians. It details the benefits, the scope of who the policy applies to, any specific exclusions, roles and responsibilities, and the process for assessment.

Does your policy specifically refer to time critical Parkinson's medications?

The policy does mention time critical medication, for example, Parkinson’s medication. Aside from a few exemptions, the policy is written to allow self administration of all medication after suitable assessment.

The policy is particularly relevant to patients taking time critical medication because it allows them to make sure they get their medication on time.

How does self administration work at UHL?

Training

Once a suitable ward has been identified, we follow a process to train the staff so they understand the benefits and risks of self administration. The training is in 2 parts: an e-learning module and an in-person follow up session with the medicines management team where they can address any questions or concerns.

Checklist completion

We work through a checklist with the ward to check it's ready to "go live". The checklist covers the staff training and necessary resources such as patient lockers and information leaflets. When this is signed off, the ward can "go live", with the medicines management team supporting self administration assessments for the initial period.

Assessments

The electronic assessment requires the staff to check the medication, both on the prescription chart and the medication boxes, to make sure that these are correct and safe to use.

Also required is a daily assessment, to make sure that the patient is still safe to self administer and check for any prescription changes. The patient is provided with a copy of their drug chart detailing the medication they are self administering, which is reprinted after any changes.

Can you explain the levels of self administration?

We have 3 levels of self administration:

• Level 1: Nurse, midwife, medicines administration pharmacy technician (MAPT) or nurse associate is to administer all medication.
• Level 2: The patient, parent, carer, or guardian can administer their medication with supervision from nurses, midwives, nurse associates or MAPT.
• Level 3: Patient, parent, carer or guardian is to self administer medication.

In your experience what percentage of patients self administer?

As a snapshot from today, 6 March 2024, out of approximately 1,900 beds, around 15 to 20 patients have had a self administration assessment. This might seem like a low number, but we don't focus on numbers. This is about patient experience and medication safety.

Do you reassess patients who are initially too unwell to self administer their Parkinson’s medications as their condition improves?

Yes, when they are well enough to self administer their medication.

Is this self administration policy applied on all wards at UHL?

Currently, we have several wards that are fully live with self administration, including 4 children’s wards. We can support ad hoc assessments for patients on wards that aren't fully live with self administration.

Do live wards have to assess all patients for self administration?

There's no requirement to assess all patients, as this would be too difficult to implement. Some patients will never be in a position to self administer due to their clinical condition.