Prevalence, nature and risk factors for medication administration omissions in English NHS hospital inpatients: a retrospective multicentre study using Medication Safety Thermometer data

Abstract

ObjectiveTo determine the prevalence, nature and predictors of patients having medication administration omissions in hospitals.MethodsAll medication administration omissions data collected using the standardised methodology of the Medication Safety Thermometer in January 2015 were examined. Hospital inpatients prescribed at least one medication were included in the analysis. Multilevel logistic regression models ascertained the effects of patients’ gender, age, number of prescribed medicines, ward specialty and medicines reconciliation initiation status on the likelihood of having omissions. Valid clinical reasons (VCRs) were excluded from regression models. A sensitivity analysis, excluding patient refusal (PR) omissions, was also conducted.ResultsThe final study sample included 5708 patients from 320 wards in 37 hospitals. Excluding VCRs, 30% of patients had medication administration omissions (95% CI 29 to 30). Approximately half of patients with omissions had refused medicines (51%, 95% CI 49 to 53). Univariable analysis suggested that all variables were significantly associated with omissions. However, in the multivariable model, significant differences were only observed regarding the numbers of medicines patients were prescribed and their ward specialty. Patients prescribed more than 20 medications were approximately five times more likely to have had omissions than patients prescribed one to four medications (OR 4.99, 95% CI 3.22 to 7.73). Patients on surgical wards were also more likely to have had omissions than those on medical wards (OR 1.58, 95% CI 1.14 to 2.18, p=0.006), but there was no significant difference when PRs were excluded (OR 0.5, 95% CI 0.27 to 1.22, p=0.473).ConclusionMedication administration omissions are a substantial problem that affect many hospital patients, and certain patient groups are at higher risk. Specific interventions are required targeting the underlying reasons for medication omissions for different patient subgroups.

Prevalence, nature and predictors of omitted medication doses in mental health hospitals: A multi-centre study

“…'Preventable' dose omissions have emerged as an important target for remedial intervention in this research. The ratio of 'preventable' to 'non-preventable' omissions that we observed appears broadly similar to data from general hospital studies [23,24,27]. Available evidence for the causes of unavailable drug related 'preventable' omitted doses from mental health hospitals [14][15][16] identifies causative factors such as medicines logistics, but detail is often limited to codes on prescription charts or brief descriptions in incident reports.…”

“…medications involved and underlying reasons especially unavailable drugs or 'blank boxes' not signed for administration which may be preventable) or predicting factors [13,21]. More in-depth investigations focusing on omitted doses have helped address these needs in general hospitals including highlighting the a significant proportion of potentially 'preventable' omissions [22][23][24], but this data may not be generalizable to mental health hospitals and the evidence base in psychiatry is largely absent except for two single site UK studies restricted to reported missing signatures for medicines administration [25] and overall omitted dose rates within elderly care [26]. This highlights a need for further research across multiple mental health hospitals that explores in detail the type, preventability Funding: The author(s) received no specific funding for this work.…”

Wrong time medication administration errors: Frequency and their causes at Adult University Teaching Hospitals in Zambia

“…The body of knowledge has established that 10% of patients are harmed by healthcare, the primary cause of which seem to be associated with adverse effects of medication (de Vries et al, 2008;Cottney, 2015;Rostami et al, 2019). Many studies have reported that these preventable drug adverse effects are caused by medication errors, the administration medication errors being the most common (Elliott et al, 2018;Rostami et al, 2019). In this study, it was found that the frequency of WTMAEs was 47.8% of which early and late time medication administration errors accounted for 47.2 and 4.9%, respectively.…”

Detecçção de eventos adversos de eventos adversos relacionados a medicamentos por meio das ferramentas Global Trigger Tool e Medication Safety Thermometer: uma revisão narrativa

“…O NHS criou, em 2010, como parte de um programa de melhoria da qualidade, a ferramenta NHS Safety Thermometer, que tem por objetivo fornecer a prevalência instantânea dos EA, através da mensuração de danos no foco do cuidado ao paciente 10 . Trata-se de um programa que inclui um conjunto de ferramentas de mensuração de prevalência de EA, chamadas de Classic Safety Thermometer, Mental Health Safety Thermometer, Maternity Safety Thermometer e Children & Young People Safety Thermometer, relacionadas individualmente aos mais diversos objetivos, como quedas, lesão por pressão, tromboembolismo venoso, infecção o trato urinário, maternidade, saúde mental, crianças e idosos e medicamentos 7,10,15,[21][22][23][24] .…”

“…Rostami et al 21 determinaram a prevalência, natureza e fatores de omissão de medicamentos em pacientes através da compilação dos dados coletados em 37 hospitais que utilizaram o MedST, em janeiro de 2015. A prevalência de omissão de medicamentos encontrada na amostra foi de 30% e a recusa pelo paciente foi a causa de 50% das omissões.…”