Care home staff make dozens of errors in administering, recording and managing medicines, reveals a study, which suggest new technology could eliminate nearly all these mistakes.
Researchers from Cardiff University compared the use of traditional medicine charts filled in by nursing and care staff with a specially-developed electronic system for managing medicines.
“There are significant challenges associated with safety, quality and accountability in medicines administration”
Even in the best care settings staff using paper records made a significant number of errors, found the in-depth study of 30 care homes in South Wales. It forms part of a project funded by the Welsh government’s Technology and Telecare Fund.
Researchers identified 23 different types of errors including doses not being recorded on charts, failure to record the time medication was given and actual medicine stocks not matching those on record.
The overall number of errors per care home resident each week ranged from 24 to 48, while errors relating directly to the administration of medicine ranged from four to 13 mistakes per resident per week, they discovered.
While none of the individual errors would harm a patient on their own, the researchers said they could not judge the potential impact of cumulative errors on patients’ welfare.
When care home staff switched to using the Proactive Care System, which was developed as part of the project, 21 out of the 23 types of error were eliminated.
The system involves using hand-held devices to scan barcodes to identify each patient and ensure medication is correctly selected and administered.
It was able to stop medicines being given to the wrong person and medicine being given at the wrong time or when it had already been taken.
On average, the system intervened nearly nine times per resident each month to stop errors being made.
Of the two remaining types of error, the Proactive Care System reduced one – where medicine is given but not recorded or left out altogether – by at least 88%.
“Ordering and managing medicines in a care home can be a full-time job, which is time that could be better spent caring for patients”
The other common mistake related to GP prescribing instructions, so was not down to care home staff and could not be solved by the technology.
The electronic system also provides real-time information to pharmacists allowing them to check prescriptions and prevent errors.
Sixteen pharmacists took part in the study and intervened in some way on 80% of prescriptions for care home residents, including double-checking new medicines and dosages and querying whether certain drugs could be used together.
The study also suggests the technology could significantly reduce the cost of drug wastage.
Initial figures indicated the system had cut the cost of returned drugs by 55% and the cost of over-stocking drugs by 22%.
“Based on these findings, it can be estimated that for the 26,000 care home beds in Wales, there is a potential annual saving of between £3.2m to £4.6m,” stated the study authors.
Leader researcher Matthew Smith said the management of medicines in care homes was “notoriously difficult”.
“There are significant challenges associated with safety, quality and accountability in medicines administration and record keeping with serious threats posed to the vulnerable patients in our care homes,” he said.
“Our evaluation has shown that many of these risks can be reduced by implementing the system and enabling pharmacists to make proactive and consistent interventions, which ultimately have a positive effect on patient safety,” said Mr Smith.
He added: “It has also shown that millions of pounds could be saved by making informed decisions on stick levels and reducing the amount of medicine that goes to waste.”
Wales’ health and social services minister Mark Drakeford said the system not only reduced wasted medicines but also saved staff time.
“Ordering and managing medicines in a care home can be a full-time job, which is time that could be better spent caring for patients,” he said.
The project was spearheaded by healthcare consultancy Beacon Digital Health, backed by Abertawe Bro Morgannwg University Health Board.
The Proactive Care System was developed by Bristol-based healthcare technology company Invatech Health.