Carers' Medication Administration Errors in the Domiciliary Setting: A Systematic Review

Abstract

PurposeMedications are mostly taken in patients’ own homes, increasingly administered by carers, yet studies of medication safety have been largely conducted in the hospital setting. We aimed to review studies of how carers cause and/or prevent medication administration errors (MAEs) within the patient’s home; to identify types, prevalence and causes of these MAEs and any interventions to prevent them.MethodsA narrative systematic review of literature published between 1 Jan 1946 and 23 Sep 2013 was carried out across the databases EMBASE, MEDLINE, PSYCHINFO, COCHRANE and CINAHL. Empirical studies were included where carers were responsible for preventing/causing MAEs in the home and standardised tools used for data extraction and quality assessment.ResultsThirty-six papers met the criteria for narrative review, 33 of which included parents caring for children, two predominantly comprised adult children and spouses caring for older parents/partners, and one focused on paid carers mostly looking after older adults. The carer administration error rate ranged from 1.9 to 33% of medications administered and from 12 to 92.7% of carers administering medication. These included dosage errors, omitted administration, wrong medication and wrong time or route of administration. Contributory factors included individual carer factors (e.g. carer age), environmental factors (e.g. storage), medication factors (e.g. number of medicines), prescription communication factors (e.g. comprehensibility of instructions), psychosocial factors (e.g. carer-to-carer communication), and care-recipient factors (e.g. recipient age). The few interventions effective in preventing MAEs involved carer training and tailored equipment.ConclusionThis review shows that home medication administration errors made by carers are a potentially serious patient safety issue. Carers made similar errors to those made by professionals in other contexts and a wide variety of contributory factors were identified. The home care setting should be a priority for the development of patient safety interventions.

Support for Australian carers from community pharmacy: Insight into carer perspectives of a novel service

“…Other intervention studies to prevent carer‐related medication errors will be used to inform future adaptations of this service. For example, Parand et al () made numerous suggestions, such as checking carer understanding of medication labelling, storage, and administration techniques. To our knowledge there is no formal training for informal carers with respect to medication management; including this aspect into a pharmacy‐delivered carer service may be particularly relevant to those carers managing multiple medications for the care receiver.…”

“…A significant role for informal carers is medication management for the person/s they support (Noureldin & Plake, ). A systematic review by Parand, Garfield, Vincent, and Franklin () explored the types of medication errors associated with carers’ administration; dosing inaccuracies were most common. Carers may face other medication‐related issues, such as ensuring medication adherence, particularly when caring for people with late‐stage dementia (Alsaeed, Jamieson, Gul, & Smith, ).…”

Reporting adverse events—Swedish Registered Nurses experience in a municipal home care context

“…Healthcare interventions are commonly delegated to unlicensed staff (Norell et al, 2013) or are performed by informal caregivers. In both cases, it is known that adverse events occur (Parand et al, 2016;Sears et al, 2013). RNs working in the municipal elderly care organization report that they have limited legitimacy, unclear responsibilities and problematic cooperation with other healthcare professionals (Törnquist et al, 2013).…”

“…Sears, Ross Baker, Barnsley, and Short () concluded that the incidence of adverse events in the home care context was 66.5%, with the most common being falls and adverse drug events. In the home care context, informal caregivers who are not formally delegated nursing interventions, but are performing them, are also involved in the adverse events, which most commonly involve medication administration (Parand, Garfield, Vincent, & Franklin, ).…”

Medication errors in the older people population

“…It has been proven that errors can be aggravated when there are several people involved in the patient´s care or if the information is not standardized among this set of caregivers [26], that the more known about the medication being taken, the greater the reduction in errors [21] and, that the information on the leaflets does not address with sufficient clarity the precautions that, based on the patient experience, should be adopted in the home for a safe use of the medication [27]. However, older patients (and particularly if they have several caregivers) do not know enough about the medication they take, do not have the appropriate help to avoid errors and the information they receive (usually dosage and frequency) does not address issues key to safe use of the drug once they are at home [28,29].…”