Reducing dose omission of prescribed medications in the hospital setting: a narrative review

Morley, Claire; McLeod, Erin; McKenzie, Duncan; Ford, Karen; Walsh, Ken; Chalmers, Leanne; Gordon-Croal, Sharon; Bayer, Glen; Peterson, Gregory M.

doi:10.1007/s40267-016-0289-2

Cited by 7 publications

(7 citation statements)

References 28 publications

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“…Whilst a number of different interventions have been suggested to reduce the burden of omitted doses in hospitals [10], pharmacy team supported medicines administration activities have received recent attention for both omitted doses [11] and to improve other aspects of medicines administration quality [12]. However, there is limited attention paid to these interventions in terms of how they are perceived and implemented, and how these factors in turn might influence their impact in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the implementation and impact of a pharmacy technician-supported medicines administration service designed to reduce omitted doses in hospitals: a qualitative study

Seston

Ashcroft

Lamerton

et al. 2019

BMC Health Serv Res

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Background Of the various types of medication administration error that occur in hospitals, dose omissions are consistently reported as among the most common. It has been suggested that greater involvement from pharmacy teams could help address this problem. A pilot service, called pharmacy TECHnician supported MEDicines administration (TECHMED), was introduced in an English NHS hospital for a four-week period in order to reduce preventable medication dose omissions. The objective of this study was to evaluate the implementation, delivery and impact of the pilot TECHMED service using qualitative methods. Methods Semi-structured interviews with pharmacy technicians, nursing staff and senior management involved with the pilot service were undertaken to evaluate TECHMED. Interviews were transcribed verbatim and analysed using the framework approach, guided by Weiss’s Theory Based Evaluation model. Results Twenty-two stakeholder interviews were conducted with 10 ward-based pharmacy technicians, nine nurses and three members of senior management. Most technicians performed a range of activities in line with the service specification, including locating drugs from a variety of sources, and identified situations where they had prevented missing doses. Nurses reported positive impacts of TECHMED on workload. However, not all technicians fully adhered to the service specification in regard to directly following nursing staff during each medication round, citing reasons related to productivity or perceived intrusiveness towards nursing staff. Some participants also reported a perceived lack of impact of TECHMED on medicine omissions. Seventeen of the 22 interviewees supported an extension of the service. There were however, concerns about the impact on technician workload and some participants advocated support for targeted service extension to wards/rounds with high schedule dose volumes and omitted dose rates. Conclusions The findings of this study suggest that the implementation of a pharmacy technician-supported medicines administration scheme to reduce omitted doses may be acceptable to staff in an NHS hospital, and that issues with service fidelity, staff resource/capacity and perceived interventions to avoid dose omissions have important implications for the feasibility of extending the service. The study has identified targets for future development in relation to individual and system factors to improve operationalisation of technician-led initiatives to reduce medicines omissions. Electronic supplementary material The online version of this article (10.1186/s12913-019-4146-6) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Evaluating the implementation and impact of a pharmacy technician-supported medicines administration service designed to reduce omitted doses in hospitals: a qualitative study

Seston

Ashcroft

Lamerton

et al. 2019

BMC Health Serv Res

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“…As one of the most commonly occurring MAEs, omitted doses have been the subject of improvement interventions in general hospitals targeting pharmacy staff/systems [27,38], nursing education, information technology and error reporting schemes [39], some with mixed results. The evidence base in psychiatry requires expansion as it is limited to a national UK benchmarking initiative [29], and two positive single site studies of awareness/benchmarking [26] and automated dispensing cabinets [40].…”

Section: Implications Of Findingsmentioning

confidence: 99%

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

et al. 2020

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Objective Limited evidence concerning the burden and predictors of omitted medication doses within mental health hospitals could severely limit improvement efforts in this specialist setting. This study aimed to determine the prevalence, nature and predictors of omitted medication doses affecting hospital inpatients in two English National Health Service (NHS) mental health trusts. Methods Over 6 data collection days trained pharmacy teams screened inpatient prescription charts for scheduled and omitted medication doses within 27 adult and elderly wards across 9 psychiatric hospitals. Data were collected for inpatients admitted up to two weeks prior to each data collection day. Omitted doses were classified as 'time critical' and 'preventable' based on established criteria. Omitted dose frequencies were presented with 95% confidence intervals (CI). Multilevel logistic regression analyses determined the predictors of omitted dose occurrence, with omission risks presented as adjusted odds ratios (OR) with 95% CI. Results 18,664 scheduled medication doses were screened for 444 inpatients and 2,717 omissions were identified, resulting in a rate of 14.6% (95% CI 14.1-15.1). The rate of 'time critical' omitted doses was 19.3% (95% CI 16.3-22.6%). 'Preventable' omitted doses comprised one third of all omissions (34.5%, 930/2694). Logistic regression analysis revealed that medicines affecting the central nervous system were 55% less likely to be omitted compared

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“…1-3 Reasons for treatment delay can be multifactorial including unavailability of medications on the patient care unit, breakdown in communication of administration or prescribing, or an insufficient number of staff to prepare, deliver, or administer medications. 4,5 Doses that are dispensed from an inpatient pharmacy for patient treatment and are unable to be found by the nurse, who is to administer the medication, are defined as a “missing dose.” Missing doses can lead to omission of doses and adverse outcomes for admitted patients. 4 Missing doses have been an area of improvement for inpatient pharmacies for decades, even predating pharmacy automation technologies such as automated dispensing cabinets (ADMs).…”

Section: Introductionmentioning

confidence: 99%

“…4,5 Doses that are dispensed from an inpatient pharmacy for patient treatment and are unable to be found by the nurse, who is to administer the medication, are defined as a “missing dose.” Missing doses can lead to omission of doses and adverse outcomes for admitted patients. 4 Missing doses have been an area of improvement for inpatient pharmacies for decades, even predating pharmacy automation technologies such as automated dispensing cabinets (ADMs). 6,7 The frequency of missing doses compared to total doses dispensed has been evaluated in previous studies and has been estimated to be under 1% of medications dispensed from the inpatient pharmacy.…”

Section: Introductionmentioning

confidence: 99%

Impact of Dispense Tracking Software on Inpatient Pharmacy Operations

Gunter

Lawson

Bondarenka

2022

Journal of Pharmacy Technology

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Background: When medications dispensed from a hospital inpatient pharmacy aren’t able to be found at their intended destination (ie, a missing dose), this can result in delayed medication administration and rework to redispense the medication. Technology advancements in the medication use process have led to development of dose-tracking software that has the capability to track medication doses throughout the medication use cycle and document a medication’s location to its destination. Objective: The primary objective of this study was to evaluate the impact of dose-tracking software on the number of inpatient pharmacy redispenses and nursing requests for missing medications. Secondary objectives included pharmacy staff satisfaction with dose-tracking software, its impact on workflow and patient safety, and compliance with dose-track scanning. Methods: The study design was a prospective, pre-post implementation to compare the requests for missing doses and associated dispenses of injectable medications during the set evaluation period. Dose-track scanning compliance data was collected and evaluated. A survey was also administered to staff to evaluate employee perception and satisfaction with usability and value of the software. Results: During the preimplementation period, 40 021 injectable doses were dispensed, and 9841 (24.6%) were documented as redispensed doses. After dose-tracking implementation, 42 975 total injectable doses were dispensed with 9839 (22.9%) being redispensed. The count of medication messages was 10 661 in the preperiod and 11 475 in the postperiod. The data were normalized using case mix index (CMI) and patient days to account for variation in severity of illness. Conclusion: Implementation of dose-tracking software showed a decrease in the percentage of redispensed injectable medications.

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Reducing dose omission of prescribed medications in the hospital setting: a narrative review

Cited by 7 publications

References 28 publications

Evaluating the implementation and impact of a pharmacy technician-supported medicines administration service designed to reduce omitted doses in hospitals: a qualitative study

Evaluating the implementation and impact of a pharmacy technician-supported medicines administration service designed to reduce omitted doses in hospitals: a qualitative study

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

Impact of Dispense Tracking Software on Inpatient Pharmacy Operations

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