Seven Out Of 10 Care Home Residents Subject To Drug Errors

Main Category: Caregivers / Homecare
Also Included In: Litigation / Medical Malpractice
Article Date: 07 Oct 2009 - 4:00 PDT

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Inadequate medical data, overworked staff, and poor teamwork are prompting the occurrence of drug errors in seven out of 10 care home residents, suggests research in Quality and Safety in Health Care.

This is despite a government pledge in 2000 to cut the number of drug errors following the publication of a report on medical mistakes.

The findings are based on a random sample of 256 residents in 55 care homes located in West Yorkshire, Cambridgeshire, and central London.

Each care home resident was taking an average of eight medicines each. One or more drug errors were made in seven out of 10 (69.5% or 178) cases, with the average number of mistakes just under two for each resident.

The potential risks were calculated using a scoring system, where 0 is no harm and 10 is death. This ranged from 2.1 for the way in which the medicine had been given to 3.7 for the way in which the resident had subsequently been monitored.

Almost a third of drugs (30%), which should have been monitored for potentially harmful side effects, were not. The drugs most likely to go unchecked were diuretics, ACE inhibitors, amiodarone, and levothyroxine.

Prescription errors, which included insufficient information on dose or route of administration, the wrong dose, or an unwarranted drug, attracted a risk score of 2.6 while dispensing errors scored 2.

Interviews with residential care home staff, doctors, and pharmacists were used to uncover potential causes.

Contributory factors included doctors who were either inaccessible, did not know the residents, or had insufficient background information on the resident's medical history when prescribing a medicine in a care home.

Other factors included inadequate medicines training; interrupted drug rounds; poor team work between the care home, GP practice, and the pharmacy; poor record keeping; and complicated administrative systems.

The authors note that care homes are very worried about medication errors. Most of those approached (72%) were keen to take part in the study, and most of the errors were outside the control of the care homes themselves.

Nevertheless, they point out: "It was clear from the interviews that no one took responsibility for the whole system," adding that communication was another issue, frequently making it difficult to know which drug "any patient should be having."

"Management within each organisation was [also] a factor, particularly when challenged to deliver a safe service within a tight budget," they add.

Older people living in care homes are especially vulnerable to drug errors, say the authors, who describe their findings as "a cause for concern." This is because residents are usually taking a cocktail of medicines and are more susceptible to drug side effects as a consequence of ageing. They may also be confused or have dementia, which limits their capacity to register what they are being given.

Source
Quality and Safety in Health Care