Assessing the risk

There are risks associated with all aspects of healthcare and each organisation accepts responsibility for the management of those risks as part of the development of their policy and governance processes.

Challenging the ‘norm’

Traditionally, the default position has been for staff to assume responsibility for the administration of medicines when people come into hospital.  This may then be followed by an individual risk assessment to determine suitability for self-administration.

Increasingly this approach is being challenged and if individuals were administering their medicines at home before they came in, they should continue to do so on admission wherever possible.

Legal liability

The organisation accepts responsibility for managing the risk involved in the provision of self-administration of medicines (SAM) for their patients and accepts liability where the policy is followed.

An Executive Lead will be nominated to have responsibility for the oversight of the policy, in line with usual governance procedures.

Virtual wards

Patients receiving care in their own home as part of a virtual ward would be expected to self-administer their medicines.  Following a risk assessment and appropriate training they may be able to self-administer more complex regimens including injectable medicines.

This may result in self-administration of some or all of their medicines.It is important that responsibilities are identified and documented to clarify which medicines are being self-administered.

Implementation

Individuals should be risk assessed from the position that they are safe to continue to take their own medicines on admission rather than not.

This overarching change of stance needs to be risk assessed at organisational level and will depend on many factors including the clinical setting and the individuals each organisation serves.

Lead Professional for SAM

It is recommended that the organisation appoints a lead professional for SAM and this individual should ensure the following are undertaken within the organisation:

• risks are assessed at organisational level, taking into account the clinical setting and patient factors
• systems are in place for training and support for healthcare professionals in matters relating to the SAM, including the maintenance of training records
• quality improvement processes to determine audit requirements and compliance are in place for self-administration, including inclusion and exclusion of individuals from self-administration

Process of individual assessment

On admission to hospital it may be assumed that each individual is able to administer their own medicines unless they are:

• acutely unwell
• medically unstable
• confused

Self administration flow chart

The flow chart below shows an overview of the individual assessment for SAM and each organisation should have an assessment process which defines whether a patient can be considered as suitable.

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