Prevalence, nature and predictors of omitted medication doses in mental health hospitals: A multi-centre study

Abstract

Objective Limited evidence concerning the burden and predictors of omitted medication doses within mental health hospitals could severely limit improvement efforts in this specialist setting. This study aimed to determine the prevalence, nature and predictors of omitted medication doses affecting hospital inpatients in two English National Health Service (NHS) mental health trusts. Methods Over 6 data collection days trained pharmacy teams screened inpatient prescription charts for scheduled and omitted medication doses within 27 adult and elderly wards across 9 psychiatric hospitals. Data were collected for inpatients admitted up to two weeks prior to each data collection day. Omitted doses were classified as 'time critical' and 'preventable' based on established criteria. Omitted dose frequencies were presented with 95% confidence intervals (CI). Multilevel logistic regression analyses determined the predictors of omitted dose occurrence, with omission risks presented as adjusted odds ratios (OR) with 95% CI. Results 18,664 scheduled medication doses were screened for 444 inpatients and 2,717 omissions were identified, resulting in a rate of 14.6% (95% CI 14.1-15.1). The rate of 'time critical' omitted doses was 19.3% (95% CI 16.3-22.6%). 'Preventable' omitted doses comprised one third of all omissions (34.5%, 930/2694). Logistic regression analysis revealed that medicines affecting the central nervous system were 55% less likely to be omitted compared

Medication Safety in Mental Health Hospitals: A Mixed-Methods Analysis of Incidents Reported to the National Reporting and Learning System

“…Patient behaviors (e.g., aggression and consistent demanding) were recently identified by nursing professionals as one of the underlying causes of medication administration errors in this setting 32 . In another study, patients’ refusal to take medicines was found to be the most common reason for dose omissions in 2 English NHS mental health trusts 53 . Supporting measures should be put in place to help hospital staff and patients mitigate such challenging scenarios, which they may frequently experience in this setting 54,55 .…”

“…55 In another study, patients' refusal to take medicines was found to be the most common reason for dose omissions in two English NHS mental health trusts. 56 Supporting measures should be put in place to help hospital staff and patients mitigate such challenging scenarios which they may frequently experience in this setting. 57,58 Another important factor identified in this study was the lack of continuity of care when patients are transferred between different care settings or providers.…”

Understanding the medication safety challenges for patients with mental illness in primary care: a scoping review

“…In recent years there has been increased attention in the published literature on medication safety for patients with mental illness in inpatient settings [15][16][17][18][19][20]. Unique risk factors associated with this patient group have been reported that can impact the safe use of medication including those related to patient-clinician relationships, patient behaviours, and impaired cognition [19,21].…”

Administration of pro re nata medications by the nurse to incapacitated patients: An ethical perspective

“…Medication administration error is a high-risk situation during medicines management and with a median of 8.0% is the primary cause of medication harm. It is characterised by errors in the timing, omitted, and wrong doses of medication in various healthcare conditions and age groups 2,3 . A multicentre study in 38 hospitals in the UK on the prevalence, nature, and predictors of medication administration omissions using the MedsST tool indicated that medication administration omission was frequent and was influenced by the number of administered medications to patients 4 .…”

“…It is characterised by errors in the timing, omitted, and wrong doses of medication in various healthcare conditions and age groups. 2,3 A multicentre study in 38 hospitals in the UK on the prevalence, nature, and predictors of medication administration omissions using the MedsST tool indicated that medication administration omission was frequent and was influenced by the number of administered medications to patients. 4 Therefore, the safety of medication administration is one of the most important initiatives for the improvement of patient safety in the healthcare system.…”