DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20214497

Medication omissions in the first 48 hours after admission: failure in prescribed medicines reaching in-patients in paediatrics wards at the University Teaching Hospitals, Children’s Hospital in Lusaka, Zambia

Martin Kampamba, Steven Mulolo, Margaret Phiri, Martha Chibale Chulu, Webrod Mufwambi, Steward Mudenda, Michelo Banda, Christabel Nang’andu Hikaambo

Abstract


Background: The first few days of in-patient care are possibly the most significant in a patient’s recovery and any omitted medications during this period may harm the patient or increase their hospital length of stay. Therefore, our study aimed at assessing the frequency of medication administration omission errors and their reasons for the omission in the paediatric wards after admission at University Teaching Children’s Hospital.

Methods: This was a descriptive study in which 259 patient files and drug charts were reviewed. Admission prescription charts were studied in detail over a period of four weeks and all drugs prescribed but then not given in the first 48 hours were recorded as omitted medications, along with the reason given for their omission.

Results: From the 259 drug charts, a total of 1598 doses of drugs were ordered within 48 hours of admission. However, from this, only a total of 1132 doses were administered with the remaining 466 doses omitted, which accounted for a frequency of 29.2%. When the frequency of medication omission errors was compared, parenteral drugs (70.8% vs. 25.3%, [p=0.0001]), afternoon shift (48.5% vs. 15.8%, [p=0.0001]), and anti-infective medications (69.1% vs. 39.4%, [p=0.0001]) were found to be the most frequently omitted medications. There were also considerably more medication omissions in patients prescribed with more medications (median number: 4, I QR [2, 6] vs. median number: 2, IQR [2, 4], [p=0. 0.001]). The most common reason for the omission was medication unavailability (89.3%), followed by work overload (71.4%), and the patient is off the ward (71.4%).

Conclusions: This study revealed that medication omissions are a continuing problem and this may result in increased morbidity and mortality rates. There is a need to put in place specific strategies to reduce this problem.

 


Keywords


Medication omissions, Administration errors, Medication errors, Paediatrics

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References


Coleman JJ, McDowell SE, Ferner RE. Dose omissions in hospitalized patients in a UK hospital. Drug safety. 2012;35:677-83.

Blignaut AJ, Coetzee SK, Klopper HC, Ellis SM. Medication administration errors and related deviations from safe practice: an observational study. Journal of clinical nursing. 2017;26:3610-23

Munzner E, Welch SA and Richardson KL. Measuring and describing dose omissions using an electronic medication management system. Journal of Pharmacy Practice and Research. 2012;42:264-7.

Lamerton AB, Morris F, Mann F, Harper L, Ashcroft DM. Evaluation of pharmacy Technician supported Medication administration rounds (TECHMED) on reducing omitted doses: a pilot randomised controlled trial and process evaluation in a university teaching hospital; 2017.

Grissinger MC. Omission of high-alert medications: a hidden danger. AJN the American Journal of Nursing. 2017;117:66-70.

Poder TG, Maltais S. Systemic analysis of medication administration omission errors in a tertiary-care hospital in Quebec. Health Information Management Journal. 2020;49:99-107.

Kalisch BJ, Xie, B. Errors of omission: missed nursing care. Western journal of nursing research. 2014;36 875-90.

Powell N, Franklin BD, Jacklin A, Wilcock M. Omitted doses as an unintended consequence of a hospital restricted antibacterial system: a retrospective observational study. Journal of Antimicrobial Chemotherapy. 2015;70:3379-83.

Kampamba M, Abanur F, Hikaambo CN, Mudenda S, Saini K, Kaonga P. Effects of medication knowledge on medication adherence among hypertensive patients at Matero level one hospital, Lusaka city, Zambia: a cross sectional study. Int J Basic Clin Pharmacol 2021a;10:893-9.

Shandilya S, Khwaja Nizamuddin MWF, Noor S, Abraham S. Omitted medications: a continuing problem. Clinical Medicine. 2015;15:12.

Green C, Du-Pre P, Elahi N, Dunckley P, McIntyre A. Omission after admission: failure in prescribed medications being given to inpatients. Clinical medicine. 2009; 9: 515.

Mueller BU, Neuspiel DR, Fisher ERS. Principles of pediatric patient safety: reducing harm due to medical care. Paediatrics. 2019;143.

Benjamin L, Frush K, Shaw K, Shook JE, Snow SK, Medicine A, et al. Pediatric medication safety in the emergency department. Paediatrics. 2018; 141.

Sutherland A, Phipps DL, Tomlin S, Ashcroft DM. Mapping the prevalence and nature of drug-related problems among hospitalised children in the United Kingdom: a systematic review. BMC paediatrics. 2019;19:1-14.

Carpenter D, Gonzalez D, Retsch-Bogart G, Sleath B and Wilfond B. Methodological and ethical issues in pediatric medication safety research. Paediatrics. 2017; 140.

Kampamba M, Demba F, Mudenda S, Mufwambi W, Zingani E, Chabala, et al. Medication administration omission errors: Frequency and their causes during medication administration process at Ndola Teaching Hospital in Zambia. African Journal of Pharmacy and Pharmacology. 2021b;15:174-82.

Ahmed T, Haq N, Ammar M, Waqas M, Minhas M. Assessment of inpatients omission errors made by nurses throughout the medication administration process. MOJ Toxicology. 2018;4:242-5.

Keers RN, Williams SD, Cooke J, Ashcroft DM. Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence. Annals of Pharmacotherapy. 2013;47:237-56.

Fekadu G, Oljira A, Geda B and Egata G. Unsafe medication administration experience in nursing practice at Public Hospitals of Harari region, eastern Ethiopia: Phenomenological Study.2010.

Feleke Yemisirach and Girma Biniyam. Medication Administration Errors Involving Paediatric In-Patients in a Hospital in Ethiopia. Tropical Journal of Pharmaceutical Research. 2010; 9.

Assiri GA, Shebl NA, Mahmoud MA, Aloudah N, Grant E, Aljadhey H, Sheikh A. What is the epidemiology of medication errors, error-related adverse events and risk factors for errors in adults managed in community care contexts? A systematic review of the international literature. BMJ Open. 2018;8:e019101.

Rasool MF, Ur Rehman A, Imran I, Abbas S, Shah S, Abbas G, et al. Risk Factors Associated With Medication Errors Among Patients Suffering From Chronic Disorders. Frontiers in public health. 2020;8.

Rostami P, Heal C, Harrison A, Parry G, Ashcroft DM, Tully MP. Prevalence, nature and risk factors for medication administration omissions in English NHS hospital inpatients: a retrospective multicentre study using Medication Safety Thermometer data. BMJ Open. 2019;9:e028170

Ross LM, Wallace J, Paton JY. Medication errors in a paediatric teaching hospital in the UK: five years operational experience archives of Disease in Childhood 2000;83:492-7.

Kampamba M, Mwanza T, Saini K, Hatwiko H, Biete L, Hikaambo CN. Wrong time medication administration errors: Frequency and their causes at Adult University Teaching Hospitals in Zambia. African Journal of Pharmacy and Pharmacology. 2020;14:362-9.

Miller MR, Robinson KA, Lubomski LH, Rinke ML, & Pronovost PJ. Medication errors in paediatric care: a systematic review of epidemiology and an evaluation of evidence supporting reduction strategy recommendations. Quality & safety in health care. 2007;16(2):116–26.

Oshikoya KA, Oreagba IA, Ogunleye O, Senbanjo I, Macebong G, Olayemi S. Medication administration errors among paediatric nurses in Lagos public hospitals: an opinion survey. International journal of risk & safety in medicine. 2013; 25:67-78.

Lawler C, Welch SA, Brien J. Omitted medication doses: frequency and severity. Journal of Pharmacy Practice and Research. 2004; 34:174-7.

Kandil M, Sayyed T, Emarh M, Ellakwa H, Masood A. Medication errors in the obstetrics emergency ward in a low resource setting. The Journal of Maternal-Fetal & Neonatal Medicine. 2012;25:1379-82.

Berdot S, Sabatier B, Gillaizeau F, Caruba T, Prognon P, Durieux P. Evaluation of drug administration errors in a teaching hospital. BMC health services research, 2012;12:1-8.