Reducing unacceptable missed doses: pharmacy assistant-supported medicine administration

Abstract

PA-supported medication rounds can significantly reduce the rate of omitted doses. This study provides evidence for a potential solution to the problem of omitted doses for hospital inpatients.

Does the introduction of pharmacy technician support during nursing medication rounds in hospital wards help reduce the number of omitted medication doses in a NHS hospital in England?

“…The pilot randomised trial of TECHMED to determine impact on omitted dose outcomes revealed that the service was associated with a similar predicted probability of a total or 'preventable' omitted dose occurring when compared to existing practice at the study hospital either during the 'active service' or 'post-intervention' periods and when compared with 'pre-implementation'. This is in contrast with indications from an earlier study of a similar service involving pharmacy assistants that it may be effective in reducing 'unacceptable' omitted doses, [12] but our study is not directly comparable as we evaluated a pharmacy technician-led service in a different hospital using a larger dataset with process evaluation. The inclusion of process evaluation interviews was important in interpreting the RCT findings by revealing the reality of service implementation and delivery for stakeholders.…”

“…This is important as interest in the concept of greater involvement of pharmacy teams in medicines administration continues to grow in the United Kingdom. [12,25,26] Process evaluation participants gave indications that a targeted approach focusing on particular medication rounds and wards where omitted doses may be more prevalent, as well as utilising pharmacy technicians on wards which they are most familiar with may help to optimize benefits of the service and maximise efficient use of limited resources. Targeting limited resources to areas of most need aligns with recent efficiency recommendations in the sector made by Lord Carter of Coles.…”

“…The most common reasons for omitted doses in hospitals include patient refusal to take the dose, prescriptions not signed to record administration or medication not available on the ward, the latter two of which could be considered 'preventable'. [5,[7][8][9]11] A number of different interventions have been suggested to reduce the number of omitted doses in hospitals including ward-based pharmacy team support, [12][13][14] nurse education/training, [15] patient self-administration programmes [16] and a mixture of approaches including an omitted dose dashboard, warning system and root cause analysis investigation. [17] Pharmacy support during medicines administration rounds may be of particular interest in the UK given how frequently 'preventable' omissions such as unavailable medicines and unsigned dose administration records cause omitted doses.…”

“…[17] Pharmacy support during medicines administration rounds may be of particular interest in the UK given how frequently 'preventable' omissions such as unavailable medicines and unsigned dose administration records cause omitted doses. A UK study [12] examined the difference in 'unacceptable' (unavailable drug or prescription not signed for administration) dose omissions between pharmacy assistant supported medicines administration and standard practice across medical and surgical wards in a hospital during two one week periods. This study found statistically significant (p<0.05) lower rates of unacceptable dose omissions compared to both intra-ward controls (pharmacy assistants were on the ward but not actively supporting nurses during medicines administration) and inter-ward controls (where no pharmacy assistant medicines administration support was provided).…”

Learning from the design, development and implementation of the Medication Safety Thermometer

“…These omission data are lower than omission rates from previous research studies, which estimate that 80% of patients have an omitted dose [32]. This variance is may be due to a number of factors such as whether studies measure the rate of omissions of doses, or the rate of patients with omitted doses [33]. Other reasons include: studies examining different drug classes or whether data are collected from electronic prescribing and administration systems, which have the potential to impact omissions and identifying the rate of omissions [34].…”