To the Editor: Two studies1,2 and an editorial3 on the vexed issue of medication errors in hospitals have recently appeared in the Journal. Yet none of them have mentioned patients, except as the passive victims of error, and all three have focused exclusively on public hospitals. This is unfortunate as, arguably, the public hospital system is evolving predominantly into a way station along the chronic illness journey within the wider health care system.

To quote an 86-year-old patient of mine: “I’ve been taking the same tablets for 30 years, but as soon as I come to hospital they take them away and give me other ones, as if I’m incapable.” Indeed.

Could patients continue taking their own regular medications (patients’ own drugs [PODs]) themselves? This would eliminate many errors of transcription and administration and eradicate in-hospital dispensing errors altogether. Although it might seem risky for patients to be given free rein with their medications, this is precisely what they are doing at home, and generally with no supervision whatsoever. Furthermore, if patients do make errors, they are more likely to omit some medications than to take toxic doses, and the consequences of such errors of omission are likely to be minor. If a self-administration system for PODs were to be implemented — including newly prescribed drugs that patients were expected to continue using on discharge, as well as medication strategies used in the home (eg, dosette boxes) — then any errors could be noted and corrected, just as a patient’s mobility is assessed before discharge.

On the other hand, it is pertinent to note that many hospital admissions arise from medication errors, with one study demonstrating that up to 30% of admissions in patients aged 75 years and over are medication-related and up to 75% are preventable.4 Clearly, certain groups of patients and certain drugs should be excluded from a POD system. A sample protocol is available from the author on request.

Would a POD self-administration system be cost-effective? Such a system has been used successfully in at least one Australian private hospital (in which I have worked) and in several hospitals in the United Kingdom.5 A systematic review has also been undertaken to examine the risks and benefits of the use of PODs, but it did not discuss the issue of self-administration.6 A MEDLINE search from 1996 onwards for patients’ own drugs/medications and self-administration yielded no results.

As always, further research is required. What my patient’s comment highlights is that patients do have autonomy and some competence, and that these factors should be taken into account in any strategies aimed at reducing medication errors.