3.1 Patient characteristics
Doctors, in line with the principles of the Hippocratic oath, “use treatment to help the sick …, but never with a view to injury and wrong-doing”, aim to ensure that medication is safe and beneficial. Upon admission to the AMU, the patient’s presenting complaint and clinical picture alongside immediate prescribing for acute treatments were primary considerations in the prescribing of medicines. Doctors acknowledged that it was important to ensure that the patient’s existing therapy should not be interrupted so long as it continued to be beneficial. The characteristics of the patient, such as confusion, dehydration, or renal function, then modified this decision and acted as a prompt for further prescribing actions. For example, if kidney function was poor, this might prompt a decision to stop, or temporarily withhold, medication, as illustrated by the following quotation: -
“We have a lot of people with renal failure, pneumonias and things, so for example, some of the [medicines that are] not continued, we identified as being nephrotoxic so we would not continue the medication”. (Doctor, 2015)
Other patient characteristics included the age of the patient and level of frailty, particularly in terms of a dose being perceived to be too high or if a patient would no longer benefit from continuation of medicines, or any further additions.