Szczepura, Ala, Wild, Deidre and Nelson, Sara, Dr.. (2011) Medication administration errors for older people in long-term residential care. BMC Geriatrics, Vol.11 (No.1). p. 82. ISSN 1471-2318

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Abstract

Background Older people in long-term residential care are at increased risk of medication prescribing and administration errors. The main aim of this study was to measure the incidence of medication administration errors in nursing and residential homes using a barcode medication administration (BCMA) system. Methods A prospective study was conducted in 13 care homes (9 residential and 4 nursing). Data on all medication administrations for a cohort of 345 older residents were recorded in real-time using a disguised observation technique. Every attempt by social care and nursing staff to administer medication over a 3-month observation period was analysed using BCMA records to determine the incidence and types of potential medication administration errors (MAEs) and whether errors were averted. Error classifications included attempts to administer medication at the wrong time, to the wrong person or discontinued medication. Further analysis compared data for residential and nursing homes. In addition, staff were surveyed prior to BCMA system implementation to assess their awareness of administration errors. Results A total of 188,249 medication administration attempts were analysed using BCMA data. Typically each resident was receiving nine different drugs and was exposed to 206 medication administration episodes every month. During the observation period, 2,289 potential MAEs were recorded for the 345 residents; 90% of residents were exposed to at least one error. The most common (n = 1,021, 45% of errors) was attempting to give medication at the wrong time. Over the 3-month observation period, half (52%) of residents were exposed to a serious error such as attempting to give medication to the wrong resident. Error incidence rates were 1.43 as high (95% CI 1.32-1.56 p < 0.001) in nursing homes as in residential homes. The level of non-compliance with system alerts was very low in both settings (0.075% of administrations). The pre-study survey revealed that only 12/41 staff administering drugs reported they were aware of potential administration errors in their care home. Conclusions The incidence of medication administration errors is high in long-term residential care. A barcode medication administration system can capture medication administration errors and prevent these from occurring. Background The care home sector is an increasingly important provider of long-term care for older people. A review of the international literature has recently identified that research in the area of quality and safety is lacking, especially for residential homes which have no on-site nursing staff [1]. A number of authors have identified prescribing and management of medication more generally as key areas for improved patient safety in care homes [2-9]. In England, over 18,000 homes currently provide beds for more than 453,000 people, compared to 167,000 beds in hospitals. The majority of residents are older people with complex health needs. Six out of ten are cared for in a residential home with no on-site nurses. In such homes the management of prescribed medication is undertaken by non-nursing, social care staff who may have had no formal training in safe practice [10]. In nursing homes, which must have a registered nurse (RN) on site 24 hours per day to meet regulation requirements, medicine administration is one of the many tasks carried out by busy RNs. In both settings, prescribing decisions are the responsibility of the general practitioner (GP) or the hospital physician. It is known that in England 45% of all care homes in 2005 failed to meet the minimum standard for medication management [4], and that this figure remains high at 28% in 2010 [11]. A cross-sectional study of a sample of 256 residents in 55 UK care homes found that 69.5% had been exposed to one or more medication errors [12]; these included mistakes made by GPs in prescribing, dispensing errors by pharmacies, and administration errors made by care home staff. To guard against drug administration errors in hospital care settings, electronic medication administration recording (eMAR) has been widely implemented to replace paper-based systems [13]. eMAR systems have now been developed for use in long-term residential care environments. It is reported that safety is now being further improved in hospitals by the use of barcode technology integrated with eMAR systems [14]. Similar systems are being developed for use in long-term residential care. We report on a study of the first barcode medication management system specifically developed for use in UK residential and nursing homes, with external pharmacy-led data capture, processing and record management. The main aim of the research was to examine the incidence of potential medication administration errors (MAEs) in nursing and residential homes using the barcode medication administration (BCMA) system. A further objective was to compare observed error rates and response to system-alerts for residential and nursing homes. Other aspects of the system such as bar-coded dispensing, clinical readings, and stock management were not considered in the present study.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General)
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Older people -- Care -- Great Britain, Old age homes -- Great Britain, Medication errors
Journal or Publication Title:	BMC Geriatrics
Publisher:	Bio Med Central
ISSN:	1471-2318
Date:	7 December 2011
Volume:	Vol.11
Number:	No.1
Page Range:	p. 82
Identification Number:	10.1186/1471-2318-11-82
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
Funder:	Pharmacy Plus (PP)
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URI:	http://wrap.warwick.ac.uk/id/eprint/40888

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