Adherence to a hospital discharge medication regime is crucial for successful treatment and to avoid increasing rates of drug resistance. A patient's success in adhering to their medication regime is dependent on many social, cultural, economic, illness and therapy-related factors, and these are often more pronounced in the developing world. Anecdotal evidence in Services Hospital, Lahore (Pakistan) suggested that the relatively high levels of illiteracy in the patient population was a major factor in poor adherence. Baseline measurement revealed that 48% of all the hospital's patients were illiterate with just 5%-12% of illiterate patients being able to interpret their handwritten discharge prescription after leaving hospital. Unsurprisingly follow-up clinics reported very poor adherence. This quality improvement project intervened by designing a new discharge prescription proforma which used pictures and symbols rather than words to convey the necessary information. Repeated surveys demonstrated large relative increases in comprehension of the new proformas amongst illiterate patients with between 23%-35% of illiterate patients understanding the new proformas.
ProblemDoctors working in follow-up outpatient clinics at Services Hospital, Lahore (Pakistan) have noted very poor levels of adherence to patient's TTO ('to take home') discharge medication regime given on previous admissions and clinics. The problem is particularly marked among the large illiterate patient population served by this hospital.This non-adherence can have serious implications for the patient's overall health outcome, with incorrectly taken medications potentially resulting in relapses of the patient's condition, medication dependence, drug resistance and potential accidental overdosing.
We present an unusual case of an acutely unwell patient with an upper gastrointestinal bleed whose resuscitation efforts were delayed by the discovery of his, similarly, acutely unwell pet on the medical high dependency unit. We highlight the challenges this provided the clinical team and focus on the issues relating to patient safety, consent and multidisciplinary action which may be more relevant to daily clinical practice.
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