Abstract
Patients admitted for allogeneic hematopoietic stem cell transplantation (allo-HSCT) are discharged with multiple new medications. At our institution, a new patient Self Medication Program (SMP) was implemented on the allo-HSCT units. An SMP allows patients to practice self-administration of medications in a controlled environment before discharge. We assessed the impact of the SMP on patient medication knowledge, self-efficacy, adherence, and safety. Patient and staff satisfaction with the SMP was also explored. Participants in the SMP group received medication counseling by a pharmacist and self-managed their medications with nursing supervision until discharge. Participants in the pre-SMP group received medication counseling by a pharmacist at discharge. All participants completed a Medication Knowledge and Self-Efficacy Questionnaire before discharge and at follow-up. Safety endpoints were assessed for SMP participants. Twenty-six patients in the pre-SMP group and 25 patients in the SMP group completed both questionnaires. Median knowledge scores in the pre-SMP group versus the SMP group were 8.5/10 versus 10/10 at discharge (p = 0.0023) and 9/10 versus 10/10 at follow-up (p = 0.047). Median self-efficacy scores were 38/39 in the pre-SMP group versus 39/39 in the SMP group at both discharge and follow-up (pdischarge = 0.11, pfollow-up = 0.10). The SMP was associated with at least 1 medication event in 7 participants, but no medication incidents. Patient and staff surveys showed a positive perceived value of the SMP. Our results demonstrate that the SMP is associated with durable, improved medication knowledge, a trend towards improved self-efficacy, and largely positive perceptions among both staff and patient participants.
Highlights
Patients admitted for allogeneic hematopoietic stem cell transplantation are discharged with multiple new medications
The previous standard of care for discharge medication education on the allo-HSCT units at the Princess Margaret Cancer Center (PM), a part of the University Health Network (UHN), was a detailed one-on-one counselling session performed by a pharmacist within 24 hours before discharge
The results of our study demonstrate that the Self Medication Program (SMP) is associated with durable, improved medication knowledge at discharge and at 3–5 weeks post-discharge when compared to the previous standard of care
Summary
Patients admitted for allogeneic hematopoietic stem cell transplantation (allo-HSCT) are discharged with multiple new medications. We assessed the impact of the SMP on patient medication knowledge, self-efficacy, adherence, and safety. Conclusion: Our results demonstrate that the SMP is associated with durable, improved medication knowledge, a trend towards improved self-efficacy, and largely positive perceptions among both staff and patient participants. Recipients of an allogeneic hematopoietic stem cell transplantation (allo-HSCT) are discharged on multiple new medications. Nonadherence to these medications can cause severe adverse effects such as myelosuppression and organ dysfunction, and lead to poor health outcomes such as infections, graft rejection, graft-versus-host disease (GVHD), and hospital readmissions. A new patient Self Medication Program (SMP) was recently implemented on the allo-HSCT units at PM. This ensures that the patient is taking the correct dose at the correct time and that each dose is documented as per hospital standards
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