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Evaluation of medication dose omissions amongst inpatients in a hospital using an electronic Medication Management System

Hunt, KV, Harding, AM, Taylor, SE and Curtain, C ORCID: 0000-0001-5029-7541 2018 , 'Evaluation of medication dose omissions amongst inpatients in a hospital using an electronic Medication Management System' , Journal of Evaluation in Clinical Practice , pp. 688-694 , doi: 10.1111/jep.12944.

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Abstract

Rationale, aims, and objectives: Whilst many dose omissions cause no patientharm, inappropriate dose omissions have been associated with increased length ofhospital stay, risk of sepsis, and mortality. This study aimed to comprehensivelydescribe the prevalence and nature of omitted doses overall and of high risk medicationdose omissions in an organization using an electronic Medication ManagementSystem.Methods: A retrospective cross‐sectional study was undertaken in an Australiantertiary referral health service. All routinely documented electronic inpatient doseadministration records from 1st July 2014 to 30th June 2015 were included. Periodprevalence and characteristics of dose omissions overall and of high‐risk medicationdose omissions were determined.Results: During the study period, 3.3 million inpatient doses were scheduled foradministration, with doses endorsed as “not given” comprising 6.2% of all scheduleddoses. Non‐valid dose omissions (medication not available or no justification documented)comprised 1.2% of scheduled doses. Patient refusal accounted for one thirdof all dose omissions, while for 12% no explanation was provided and 7% wereendorsed “medication not available”. High‐risk medications accounted for 20% of alldose omissions. One in 20 antimicrobial doses scheduled were omitted, and of these,17% were due to patient refusal.Conclusion: The period prevalence of dose omissions in this large study after electronicMedication Management System implementation is similar to that found whenpaper charts were used. Although most dose omissions appear appropriate, manyorders were not given due to patient refusal or with no documented justification.Interventions to minimize unintentional dose omissions are indicated.

Item Type: Article
Authors/Creators:Hunt, KV and Harding, AM and Taylor, SE and Curtain, C
Keywords: informatics, clinical audit, clinical safety
Journal or Publication Title: Journal of Evaluation in Clinical Practice
Publisher: Blackwell Publishing Ltd
ISSN: 1356-1294
DOI / ID Number: 10.1111/jep.12944
Copyright Information:

© 2018 John Wiley & Sons, Ltd.

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