Abstract
BackgroundOlder 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.MethodsA 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.ResultsA 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.ConclusionsThe 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.
Highlights
Older people in long-term residential care are at increased risk of medication prescribing and administration errors
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 general practitioner (GP) in prescribing, dispensing errors by pharmacies, and administration errors made by care home staff
We report on a study of the first barcode medication management system developed for use in UK residential and nursing homes, with external pharmacy-led data capture, processing and record management
Summary
Older people in long-term residential care are at increased risk of medication prescribing and administration errors. The care home sector is an increasingly important provider of long-term care for older people. A number of authors have identified prescribing and management of medication more generally as key areas for improved patient safety in care homes [2,3,4,5,6,7,8,9]. 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 been developed for use in long-term residential care environments. It is reported that safety is being further improved in hospitals by the use of barcode technology integrated with eMAR systems [14]. Similar systems are being developed for use in longterm residential care
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