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Non-Therapeutic Medication Omissions: Incidence and Predictors at an Australian Hospital

ABSTRACT Background: The inconsistent definition of non-therapeutic medication omissions, under-reporting, and a poor understanding of their associated factors hamper efforts to improve medication administration practices. Aim: To examine the incidence of non-therapeutic medication omissions among acutely ill medical and surgical adult patients; and to identify the patient-, drug-and system-related predictors of these omissions. Method: A medication chart audit of 288 acutely ill adult medical and surgical patients admitted to 4 target wards (2 surgical and 2 medical) at an Australian hospital. Patients admitted to these wards from December 2008 to November 2009, with at least one regularly prescribed medication, were eligible. The sample was stratified according to gender, season and ward. A medication chart audit identified medication omissions, and data were collected on gender, age, length of stay, comorbidities, medication history and clinical pharmacy review. Results: Of the 288 medication charts audited, 220 (75%) had one or more medication omissions. Of the 15 020 medication administration episodes, there were 1687 omissions, resulting in an omission rate per medication administration episode of 11%. Analgesics and aperients were the most frequently omitted medications, with failure to sign the medication record and patient refusal, the main reasons for omission. Female gender (p < 0.001) and the number of medication administration episodes (p < 0.001) were statistically significant predictors of non-therapeutic medication omissions. Conclusion: The high incidence of medication omissions suggests there is need for an agreed definition of medication omission and its inclusion as a reportable incident. Increasing medication reconciliation via implementation of the Medication Management Plan may also reduce the opportunity for error. J Pharm Pract Res 2011; 41: 188-91.

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    ABSTRACT: Background Little is known about the influences on nurses’ decisions to withhold surgical patients’ oral medications pre and postoperatively or the degree to which decisions are consistent. The literature is devoid of information that clarifies whether or at what point withholding a particular oral medication may constitute a medication error. Purpose This study sought to redress this gap in knowledge and identify factors influencing nurses’ decisions about withholding surgical patients’ oral medications. Methods This interpretive study recruited a convenience sample consisting of nine nurses from surgical wards in public and private hospitals on the Gold Coast, Queensland and northern New South Wales to participate in individual interviews. Data were transcribed and analysed using inductive content analysis to identify common themes. Findings Three main themes illustrated important influences on nurses ‘decisions, including ward culture, nurses’ perceptions of their roles and patient factors. Conclusions The complex issues surrounding nurses’ decisions when withholding surgical patients’ oral medications are identified in this research. The findings will help to inform quality and safety in future medication management and lead to higher quality and safer patient care.
    Collegian Journal of the Royal College of Nursing Australia 07/2013; 21(4). · 0.84 Impact Factor

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May 22, 2014