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A comparison of medication administration errors from original medication packaging and multi-compartment compliance aids in care homes: A prospective observational study

Gilmartin-Thomas, JF-M; Smith, F; Wolfe, R; Jani, Y; (2017) A comparison of medication administration errors from original medication packaging and multi-compartment compliance aids in care homes: A prospective observational study. International Journal of Nursing Studies , 72 pp. 15-23. 10.1016/j.ijnurstu.2017.03.008. Green open access

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Abstract

Background No published study has been specifically designed to compare medication administration errors between original medication packaging and multi-compartment compliance aids in care homes, using direct observation. Objectives Compare the effect of original medication packaging and multi-compartment compliance aids on medication administration accuracy. Design Prospective observational. Setting Ten Greater London care homes. Participants Nurses and carers administering medications. Methods Between October 2014 and June 2015, a pharmacist researcher directly observed solid, orally administered medications in tablet or capsule form at ten purposively sampled care homes (five only used original medication packaging and five used both multi-compartment compliance aids and original medication packaging). The medication administration error rate was calculated as the number of observed doses administered (or omitted) in error according to medication administration records, compared to the opportunities for error (total number of observed doses plus omitted doses). Results Over 108.4 h, 41 different staff (35 nurses, 6 carers) were observed to administer medications to 823 residents during 90 medication administration rounds. A total of 2452 medication doses were observed (1385 from original medication packaging, 1067 from multi-compartment compliance aids). One hundred and seventy eight medication administration errors were identified from 2493 opportunities for error (7.1% overall medication administration error rate). A greater medication administration error rate was seen for original medication packaging than multi-compartment compliance aids (9.3% and 3.1% respectively, risk ratio (RR) = 3.9, 95% confidence interval (CI) 2.4 to 6.1, p < 0.001). Similar differences existed when comparing medication administration error rates between original medication packaging (from original medication packaging-only care homes) and multi-compartment compliance aids (RR = 2.3, 95%CI 1.1 to 4.9, p = 0.03), and between original medication packaging and multi-compartment compliance aids within care homes that used a combination of both medication administration systems (RR = 4.3, 95%CI 2.7 to 6.8, p < 0.001). A significant difference in error rate was not observed between use of a single or combination medication administration system (p = 0.44). Conclusion The significant difference in, and high overall, medication administration error rate between original medication packaging and multi-compartment compliance aids supports the use of the latter in care homes, as well as local investigation of tablet and capsule impact on medication administration errors and staff training to prevent errors occurring. As a significant difference in error rate was not observed between use of a single or combination medication administration system, common practice of using both multi-compartment compliance aids (for most medications) and original packaging (for medications with stability issues) is supported.

Type: Article
Title: A comparison of medication administration errors from original medication packaging and multi-compartment compliance aids in care homes: A prospective observational study
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.ijnurstu.2017.03.008
Publisher version: http://doi.org/10.1016/j.ijnurstu.2017.03.008
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Medication errors; Medication safety; Nurses; Nursing homes
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy > Practice and Policy
URI: https://discovery.ucl.ac.uk/id/eprint/1553312
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