Presentation on theme: "Care Homes’ Use of Medicines Study (CHUMS) – Identifying and preventing medication errors in care homes Dr David Alldred Lecturer in Pharmacy Academic."— Presentation transcript:
1 Care Homes’ Use of Medicines Study (CHUMS) – Identifying and preventing medication errors in care homesDr David AlldredLecturer in PharmacyAcademic Unit of Medicines ManagementUniversity of Leeds
2 BackgroundPatient safety initiatives of early 2000’s supplemented by DH policy research initiative:Patient Safety Research Portfolio at:Commissioned research on medication errors in care homes.Care Homes’ Use of Medicines StudyProf Nick Barber (University of London)Prof Theo Raynor (University of Leeds)Prof Peter Buckle (University of Surrey)
3 Care homes’ use of medicines study (CHUMS) AimsTo identify the frequency and causes of medication errors (prescribing, monitoring, dispensing, administration)To determine the potential harmTo suggest solutions(Alldred et al 2009; Barber et al 2009)
4 Methods256 randomly selected residents from 55 homes in W Yorks, Cambs and London (38 mixed care)Visited homes:observed staff/recordsobserved medicinesobserved administrations (2 drug rounds/resident)interviewed care home staff.
5 Results Mean age 85, on mean of 8 meds 7 out of 10 residents were exposed to at least one medication error (mean of 1.9 errors/resident)Prevalence of prescribing errors 8.3% of medicines (39% of residents)Monitoring errors 14.7% of medicines (18% of residents)Dispensing errors 9.8% of medicines (37% of residents)Administration errors 8.4% (22% of residents)
7 Administration errors Prevalence of 8.4% (1 in 12)Half were omissions, one-fifth wrong doseResidential > Nursing? (adjusted OR % CI 0.96 to 3.25)
8 Types of administration errors Omission Allergy error Extra dose(s) Wrong dose Unprescribed drug Drug incorrect Formulation error Route errorDeteriorated drug Timing error
9 Omission: Fluoxetine 20mg capsules were prescribed “one daily” for depression and not administered for 6 days as drug not in stock.
10 Wrong dose: Casodex® (bicalutamide) 150mg tablets “one daily” were prescribed by the hospital for prostate cancer; the prescription was continued by the GP generically as bicalutamide and administered simultaneously.
11 Wrong dose: Glyceryl trinitrate patch prescribed generically “5mg/24 hours take HALF daily” for ischaemic heart disease. A patch was cut in half and applied to the resident’s chest despite the fact that the contents were leaking out.
12 Formulation and dispensing systems Compared different formulations to see if any difference in error ratesMonitored dosage systems versus manufacturers’ packaging(Alldred et al 2011)
13 Formulation and dispensing systems When compared to tablets/capsules in MDS, error rates were:Liquids – 4 times higherOmissionsNot shaking bottleInaccurate measurement(Alldred et al 2011)
14 Formulation and dispensing systems When compared to tablets/capsules in MDS, error rates were:Topical/transdermal/injections – 19 times higherOmissionsWrong dosesExpired(Alldred et al 2011)
15 Formulation and dispensing systems When compared to tablets/capsules in MDS, error rates were:Inhalers – 30 times higherNot shaking deviceResident not holding breathSpacer not usedWrong number of puffs(Alldred et al 2011)
17 Formulation and dispensing systems When compared to tablets/capsules in MDS, error rates were:Tablet/capsules not in MDS – twice as high(Alldred et al 2011)
18 Drug sensitivities Record review of 121 residents in 31 homes 31 (26%) had ≥1 documented sensitivity48 sensitivities in totalNumber of sensitivities recorded by:GP (73%)Care home records (60%)Medicines administration record 3 (6%)Only 2 sensitivities documented on all three records(Alldred et al 2010)
22 Causes of errors (CHUMS) Lack of patient awareness of medicinesPhysical problems e.g. dysphagia, arthritisDispensing and ordering systemsLack of protocolsLack of knowledge and trainingTired, unwell, stressed etc.Verbal rather than written culture
23 Causes of errors (CHUMS) Time pressureStaff turnoverDrug round interruptions (up to 12 per hour)Poor communication with pharmacy and GPLack of support from other healthcare professionalsInaccurate medicines administration recordsPhysical environment –unpleasant smells, poorly lit, noisy, shortage of space
24 Solutions Improve/increase education and training Drug round breaks Redesign the drug trolleyReduce number of medicines/dosesPrescribe medicines more evenly over the dayImprove communication with, and support from, other healthcare professionalsAdequate policiesTechnology e.g. barcoding, ordering systems
25 Summary Prevalence of administration errors is high and needs reducing Medicine-related and patient-related factors may increase the risk of errorCauses are multipleSolutions need to be developed to improve systemsTechnology has a role
26 ReferencesAlldred et al The influence of formulation and medicine delivery system on medication administration errors in care homes for older people. BMJ Qual Saf DOI: /bmjqs Alldred et al The recording of drug sensitivities for older people living in care homes. Br J Clin Pharmacol 69: Alldred DP et al Care home use of medicines study. Medication errors in nursing and residential care homes – prevalence, consequences, causes and solutions. Report to the Patient Safety Research Portfolio. Available at Barber ND et al The Care Homes’ Use of Medicines Study: prevalence, causes and potential harm of medication errors in care homes for older people. Qual Saf Health Care 18, pp Available at Dean B, Barber N Validity and reliability of observational methods for studying medication administration errors. Am J Health System Pharm 58:54–9.