A study found that nursing homes commit medication errors 21.2 percent of the time. The study observed 2,025 instances of medication dispenses and found that 428 of them were in error. Regardless of error rates, nursing homes will only continue to grow in size and importance. It is projected that nearly one in five Americans will be over 65 by 2050. As retired Americans make up a larger proportion of the population, nursing homes and other care programs will be placed under steadily increasing strain.
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Automated Medication Dispensaries
The study was conducted to determine the efficacy of automated medication dispensary systems. These systems were introduced in hospitals to reduce human error. Unfortunately this study found that nursing homes, despite the automated dispensary are still prone to commit errors.
Automated medication dispensers have been used to great effect in hospital pharmacies. Studies have consistently found that they reduce the rate of errors by 10 to 16 percent however this study did not find comparable reductions in nursing homes.
The study was conducted over two weeks in three nursing homes which cared for 180 patients. All medication was prescribed by a specialized attending physician. All of the nursing homes relied upon one community pharmacy which used an automated medication dispenser. The robot packaged the medication, placed it into plastic bags and labeled them. The pharmacy technicians collected those bags and organized them according to patient. The nursing home attendants then collected the bags once a week.
The study found that the robot dispensed the medication accurately and correctly. However it did note that errors begin to crop up when the nursing attendants administered the medication to their patients.
Trained pharmacy technicians followed and observed nursing home attendants. The attendants did not know they were the subject of the study, as far as they knew the technicians were studying the medication dispensing system. The technician noted the patient, time and medication given. The technicians refrained from intervention unless a particular error was dangerous for a patient’s health.
The study classified the errors into five categories:
- Omissions which were failures to give medication to a patient or giving medication to the wrong patient.
- Unordered medication which occurred when patients are given the incorrect medication.
- Incorrect administration technique which occurred when the attendant improperly gave the medication to the patient. For example, crushing a tablet that should not be crushed or failure to supervise patient ingestion of the medication.
- Wrong dose errors. For example, giving someone the incorrect milligrams or number of tablets.
- Finally, wrong time errors which occurred when medication was given at the incorrect time. Any medication given 60 minutes too early or too late, were defined as “wrong time.”
The study also classified the severity of the errors. For instance, an error may occur but is corrected before it reaches the patient is a light error. An error that was improperly administered to the patient but is not immediately life threatening is an intermediate error.
The study’s findings are quite disturbing. It found that errors occurred 21.2 percent of the time out of 2,025 administrations to 127 patients. The most frequent errors by far were incorrect administration techniques which accounted for 73 percent of all errors. The second most common mistakes were wrong time errors which accounted for 18 percent.
It appears that nursing attendants fallback on the default treatments for patients, rather than reading the medication label. Many people living in nursing homes are unable to consume solid foods, let alone swallow pills, therefore attendants crush all of their tablets. However, crushing a table and mixing it in a liquid can reduce the efficacy of the medication which is why there are labels detailing proper administration technique.
Attendants also tended to be more careless with patients with whom they were familiar. This caused them to omit observing these patients as they ingested their medication. Observation of patients is critical, especially if they suffer from Alzheimer’s or dementia due to their condition.
There are two types of timing errors (1) administering medication outside of the ingestion window and (2) administering medication too late after a meal was eaten. Certain medications need to be taken at the same time every day to maximize their efficacy. Additionally, some medications must be ingested with food or immediately afterward or risk discomfort for the patient. This timing is critical to the health of the patient.
The study found that, unlike in hospitals, automated dispensaries are not the cure-all for nursing homes. Nursing attendants must give medications to multiple patients in often complex administration techniques. This variable environment reduces the effectiveness of the robot because it is unable to account for these human errors.