Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more

Are omitted and delayed medication drug errors?

  • Comments (20)

Although the National Patient Safety Agency published a Rapid Response Report on reducing harm resulting from omitted or delayed medication in 2010, omitted doses continue to occur frequently. The Francis report raised awareness of the problem and its potential impact on patient care.

 

Should omitted drugs and delays in medicine administration be reported as drug errors?

 

Audit of missed or delayed antimicrobial drugs

  • Comments (20)

Readers' comments (20)

  • reporting everyone of these incidents individually would be a massive increase to our workload but perhaps a log where record missed meds and the reason could be used as evidence for audit etc.

    For me unless a drug is a stat dose or particularly time dependent delays are not a big deal. omitted meds on the other hand is potentially a big problem. Hospital pharmacy services need to have some kind of rapid access service where critical meds can be dispensed immediately without going through the normal lengthy checking system (perhaps a nurse could second check on collection). I can phone my pharmacist directly, tell them it's urgent and still wait 5 hours plus for it to arrive on the ward.

    The other big problem is the lack of clear guidance on IV antibiotics. Say a patient is prescribed IV benzylpenicillin 1.2g QDS, the doses will be 6 hours apart and the script may say 6hrly. When a dose is then late because of stock, staffing or just because you have other patient's with IVs at the same time, many staff will follow the script to the letter and ensure a full 6 hour gap before the next dose. You cannot blame nurses for this as they are following the script an if you question a medic or pharmacist they will fail to grasp the problem and tell you to give at the time it is prescribed. logic tells you that this only has to happen 2-3 times for the delay to be sufficient to indicate omitting a dose to then get the next one on time. I am of the school of thought that as long as we leave a sensible gap between doses (say 4hrs for 6hrly, 6hrs for 8hrly etc.) it is better to try and catch up missed doses, making up the time of the next 1-3 doses as necessary. This ensures the patient has the intended therapeutic level of the drug in their system. However all I have to back this approach is that the BNF doesn't state minimum times between doses and regimes for certain conditions require theses antiboitics to be given more frequently.

    Lots of meds are omitted for medical reasons as well e.g. BP, HR, renal function, and I think we should defer rather than omit and medics should take responsibility withholding the dose as criteria for this varies across departments (unless we put SOP in place).

    Overall any nurse can tell how and why a large number of medications are delayed or omitted. The challenge is making the changes to the systems to give nurses the tools to ensure the only meds omitted are done so for a clinical reason.

    Unsuitable or offensive? Report this comment

  • Anonymous

    how long is a delay? - if you give out pills for 30 patients they will not all get them on time.

    Unsuitable or offensive? Report this comment

  • Anonymous

    Depends what you define as an omission or a delay. Some delays have greater implications than others, some omissions have clear clinical reasons.

    Unsuitable or offensive? Report this comment

  • Anonymous

    We operate on the basis that a drug is not late [or early] unless more than 25% out of time. This allows some flexibility and seems to be sensible.
    If a drug is particularly time sensitive or critical the above does not apply.

    Unsuitable or offensive? Report this comment

  • Anonymous

    Working in a nursing home and having responsibility for the medication round for 18 residents. With doctors coming in, and telephone calls....constant interuprtions, means some days the 9am meds dont get to the residents until after 11am.......Then I am in deep doo doo here. What else can I do? I dont get stressed about it, I ensure time dependant meds are given as close as possible to the time they are meant to be taken and carry on with the rest.
    Most people are no compliant with their meds at home, I reckon they are getting more being in the home with us than they would be if they were at home

    Unsuitable or offensive? Report this comment

  • Anonymous


    Eileen - if you are the only nurse on duty how can you give out meds to 30 patients at the same time?
    If delays are reported as drug errors do you think we will get more staff in to do the drug rounds or do you think patients will have to start self-medicating?

    Unsuitable or offensive? Report this comment

  • Anonymous

    18 residents is the average size of a team on a ward. Bear in mind there are no iv's or injections as District Nurses administer in the community. I work with a team in a nursing/residential home. we have 39 residents. Yes there are 1 or 2 who don't like taking their medication but using my own judgement, as the NMC (2008) guidelines indicate, i allocate care staff to ensure that they are supervised whilst taking their medication. They are trained following completing the medicine management training. Personally i feel it's about balancing trust, team work and efficiency SAFELY! If you have a dynamic team of seniors and hcas it helps, however communication from the rgn / rmn is the driving tool.

    Unsuitable or offensive? Report this comment

  • Anonymous

    Delays is always a problem, but not an error if there are valid reasons for it. Getting the drug from phamacy, although the pharmacy porters we have are fantastic, they can only come as fast as their legs can take them. I cannot say how fast it is processed in pharamacy though.
    On the elderly ward, over half our patients need help with feeding, we nurses are told to help feed patients first then do the drugs or do the drugs first then help with feeding. The meal time and medication time clash and as we are so short of HCAs the nurses have to delay the medication to feed patients.
    I do feel that medication administration should not have to compete with another job that can be done by an HCA, but as said before by so many we do have a real problem with skill mix and staff to do the work.
    Another problem encountered is with the doctors.
    They don't review medication as timely as they should, also when they write in a new once only drug for a specific time most times never let the nurse know.
    Elderly patients most need help to take their medication and just imagine the nurse has to help feed then do the administration which seem to take forever, no wonder a delay.
    Medication administration is very important for the patients so nurses should be supported in this by pharmacy and managers.

    Unsuitable or offensive? Report this comment

  • Anonymous

    My medication round takes a long time. I don't know if any one agrees with me but when you are looking after a lot elderly patients who are on loads of medication ,nebs ect you have to sit with them and help them. None of my patients will pick up the tot and do it on their own. The majority have swallowing difficulties and following Speech Language Therapist I have to stop if the patient starts coughing. Or they will have massive tablets and they are unsafe to swallow so I am chasing pharmacy for alternatives routes because I don't want to crush a medication that's not licenced to crush. I did this to get a liquid medication I did get it in the end, but I had lecture first from pharmacy assistant over cost and not to loose the bottle!! So yes sometimes its delayed but I will clearly document , tell pharmacy and doctor why , and them when the medication arrives I will document why its late. I am a newly qualified nurse drug rounds frighten me and I am still doing mine half hour later when everybody has finished. Then sometimes dementia patients refuse so what do I do? And finally, all the distractions, and drugs you can never find on the ward. Three days ago, a doctor prescribed medication for a patient as stat dose and never told me so it was an hour late. Every time I am panicking and thinking I will end up in NMC court because I take time, hopefully with confidence I will be quicker but frail elderly its hard and your doing your best getting alternative routes so you dont omit.

    Unsuitable or offensive? Report this comment

  • Anonymous

    I left quite a well paid job close to home in order to stop having to do endless drug rounds. By the time I had finished the drug round it was late morning. 99% of patients needed help to take their meds and were polypharmacy. I then started all over again with the lunchtime meds.

    Unsuitable or offensive? Report this comment

Show 1020results per page

Have your say

You must sign in to make a comment.

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.