Predicting medication omission: a foundation for evidence-based strategies to improve patient safety.

Abstract

OBJECTIVES The aim of this study was to identify the incidence and predictors (in terms of patient, system and drug related factors) of non-therapeutic medication omission amongst acutely ill medical and surgical adult patients; which relates to the conference theme of clinical governance, incorporating quality and safety, research and evidence. METHODS A chart audit of 288 acutely ill adult medical and surgical patients admitted to four wards in an Australian hospital. All patients admitted to these wards from December 2008 to November 2009, and who had at least one regularly prescribed medication, were eligible for inclusion in the sample. The sample was stratified according to gender, season and ward. The audit identified non-therapeutic medication omissions, and collected data on gender, age, length of stay, co-morbidities, medication history, and clinical pharmacy review. RESULTS In total, 220 of the 288 patients (74.6%) experienced one or more medication omissions. Of the 15,020 medication administration episodes, there were 1,687 omissions, resulting in an omission rate per medication administration episode of 11.2%. Analgesics and aperients were most frequently omitted, with failure to sign the medication record and patient refusal, the main reasons identified. Gender (females) (p < 0.001) and total medication prescriptions (p < 0.001) were statistically significant predictors of omissions. CONCLUSIONS Limited recent research into this area means this study provides foundational knowledge into this type of medication error. Patient safety is the cornerstone of this research with numerous recommendations for clinical practice changes emerging from this study. The high incidence of medication omissions suggests the need for the inclusion of omissions as a reportable incident. The development of 'have you signed your medication chart' stickers may provide clinicians with visual reminders and prevent possible medication 'double dosing'. Finally, increasing medication reconciliation through the implementation of the Medication Management Plan may also reduce the opportunity for error. HOW DOES YOUR WORK IMPROVE PATIENT CARE? Medication administration is complex and involves many members of the health acre team: doctors, nurses and pharmacists. The underpinning aim of this work is patient safety related to medication administration practice. The foundational knowledge provided by this study provides a beginning understanding of the incidence and possible predictors of this type of medication error. This study highlighted a number of areas for improvement in clinical practice, as well as supporting the current Australian Commission on Quality and Safety in Health Care initiatives related to safe medication administration and medication reconciliation.