Abstract
Aim Omitted and delayed medicines were found by the National Patient Safety Agency (NPSA) to be the second-largest cause of reported medication incidents.1 Between a period of 2006 to 2009 on incidents reported via the Reporting and Learning System (RLS), there were 21,383 recorded incidents of which 27 caused death and 68 caused severe harm as a direct result of omitted and delayed medication.
Children’s services at the Foundation Trust covers more than 80,000 patients per year: in a one-year period, there are over 77,000 doses of medications administered on the acute paediatric wards. The aim of this audit was to review the current practice of medication administration and documentation in paediatric inpatient wards, while identifying areas for improvement in medication administration practices and developing targeted interventions to enhance patient safety.
Methods Medication administration data on the electronic prescribing system on three paediatric wards was prospectively collected over a one week period in July 2023, using a 95% confidence interval. All inpatient medications were included (aside from day cases), and the data collection included the identification of delayed or omitted medications, documentation of the reasons behind these incidents in the clinical notes, and an assessment of the potential impact on patient care. The paediatric clinical nurse educator and clinical governance pharmacist were consulted, to ensure relevant information was included prior to data collection.
Results Of 1165 medication administrations over the audit period, 13% of the doses were not administered prior to the next dose due, 12.2% of critical medicines were not administered within 2 hours and 10.3% of antibiotics for sepsis were not administered within 60 minutes. Analysis of the data indicated that antibiotics, analgesics and anti-epileptics were the highest medication classes where dose omissions and delays occurred. Of these, there were two instances of patients spiking a temperature, one patient missing multiple doses due to a lack of IV access and two patients not receiving their antibiotics due to delays in ordering stock. Two-thirds of the medication errors involved IV medications, in mostly critically unwell patients where the enteral route was not appropriate.
Conclusions The audit highlights a significant occurrence of delayed or omitted medications on acute paediatric hospital wards, with a lack of adherence to local policy to record reasons for omitting or delaying medication. These findings emphasise the urgent need for interventions to improve medication administration practices, such as education programmes, improved communication between healthcare professionals and implementation of barcode scanning.2 3 Following this, there has been an identification in development of a critical list of omitted and delayed medications for paediatric patients, to include various stakeholders of the paediatric prescribing and administration team.
References
National Patient Safety Agency. Rapid Response Report NPSA/2010/RRR009: Reducing harm from omitted and delayed medicines in hospital. National Reporting and Learning Service. 2010. https://webarchive.nationalarchives.gov.uk/ukgwa/20171030124648/http://www.nrls.npsa.nhs.uk/resources/type/alerts/?entryid45=66720 (Accessed 3 July 2023).
Ghaleb MA, Barber N, Franklin BD, Wong IC. The incidence and nature of prescribing and medication administration errors in paediatric inpatients. Arch Dis Child 2010;95:113–8.
World Health Organization. Medication safety in high-risk situations. Patient Safety Solutions 2022;2:1–8.
