Development and validation of criteria to identify medication-monitoring errors in care home residents

Abstract

Aim The identification of medication‐monitoring errors requires a validated definition. This paper describes the development and validation of a definition which includes criteria for specific medicines to determine whether a medication‐monitoring error has occurred in the care home setting. Setting Criteria were developed for older people (aged 65 years or older) living in care homes. Methods Criteria were developed by two clinical pharmacists using published guidelines. The criteria were divided into those relating to initiation of therapy and maintenance monitoring. The study steering group, made up of clinical pharmacists, a general practitioner (GP) and pharmacy academics, then reviewed the criteria and a consensus was achieved. The criteria were then reviewed by a sample of 21 GPs and 11 clinical pharmacists. The threshold for acceptance for each criterion was set at 70% by agreement of all participants. Key findings The definition of a medication‐monitoring error was accepted as ‘when a prescribed medicine is not monitored in the way which would be considered acceptable in routine general practice. It includes the absence of tests being carried out at the frequency listed in the criteria for each medicine, with tolerance of +50%’. Seventy per cent agreement was reached on all criteria for the initiation of therapy, except warfarin (69%), and on all criteria for maintenance monitoring, except penicillamine (63%) and potassium (63%). Conclusions To our knowledge, this is the first study to define a medication‐monitoring error, and to determine and validate specific criteria to identify such errors in older people living in care homes.

Safety of medication use in primary care

“…Although the use of varying error definitions by researchers in determining error rates has been previously identified,[8,36,37,103] this review has confirmed that this problem still exists. This is reflected in the wide range (<1–>90%) of error rates reported.…”

“…Monitoring -deviations from monitoring standards (Alldred et al [37] ); Dispensing -deviations from prescriptions and orders (Beso et al, 2005 [38] ); Administrationvariations between prescriptions and administrations (Dean and Barber, 2001 [39] ) Prescribing -8.3% (95% CI 7.1-9.5);…”

The causes of prescribing errors in English general practices: a qualitative study

“…Five members of the research team then decided whether these fitted pre-specified definitions for prescribing and monitoring errors (Box 1). [10][11][12] A wide range of different types of errors were purposefully selected, including those that were considered particularly serious, a range of different types of potential prescribing and monitoring errors, potential errors involving problems at the primary-secondary care interface, and less serious problems, where GPs may have wished to debate whether or not an error had taken place. Letters were distributed to prescribers potentially responsible for these errors inviting them to participate in a face-to-face semi-structured interview.…”

Care homes' use of medicines study: prevalence, causes and potential harm of medication errors in care homes for older people

“…The number of opportunities for error (denominator) was the number of prescription items written, plus any omissions. The three pharmacists worked to a common detailed protocol when reviewing the residents and their medicines, were trained together at the start of the study and had regular review meetings to ensure consistency. Monitoring errors were identified according to the definition developed and validated by Alldred et al 27 as “A monitoring error occurs when a prescribed medicine is not monitored in the way which would be considered acceptable in routine general practice. It includes the absence of tests being carried out at the frequency listed, with a tolerance of +50%.…”