Medication Management: An overlooked aspect of the Hospital Acquired Deconditioning Syndrome? A Quality Improvement Project

Introduction: Hospital Acquired Deconditioning (HAD) describes a patient’s reduction in performance following hospital admission. Medication review and assessment of medication management is a component of Comprehensive Geriatric Assessment. Hospital admission may necessitate the temporary transfer of medication administration to healthcare staff. For some patients, this may result in deterioration in medication management skills that impact discharge planning. This may be avoidable if individuals are supported to maintain these skills in hospital.

Method: Two PDSA cycle quality improvement project evaluating current practice and developing strategies for early recognition of medication management specific rehabilitation goals. PDSA 1: Patient Oriented Medication System (POMS) data from different time points in patients’ hospital stay were collected for 28 inpatients and 20 consecutive rehabilitation ward admissions (April-May 2025). PDSA2: Staff questionnaire exploring barriers perceived to promoting independence in medication management and introduction of bedside flashcards to highlight patients with medication management rehabilitation goals.

Results: PDSA 1: Only 29% (n=14) of patients had POMS frameworks completed on admission. This increased to 83% (n=39) on admission to rehabilitation ward. Of the 44% patients (n=21) who were independently managing medication prior to admission, none were supported to return to self-administration on the ward. PDSA 2: Barriers to facilitating practice and independence with medications were multifactorial. The introduction of a visual prompt at the bedside allowed members of the multidisciplinary team to consider incorporating medication management goals within rehabilitation plans.

Conclusion: Reduction in medication management skills is an important and potentially overlooked aspect of the HAD. Early assessment and identification of individuals independently managing their medication at the outset of their admission is important to ensure appropriate support is put in place to ensure this skill is preserved.