A new study published today in the Journal of Advanced Nursing has shown that nearly 40% of observed drug administrations involved errors. Patients with swallowing difficulties were at three times greater risk of medication errors being made . Earlier research has shown that patients with swallowing difficulties (dysphagia) spend 40% longer in hospital than those without dysphagia.
A total of 2129 medicine administrations were observed in a range of different hospitals and 817 involved an error. Medication administration errors for patients with swallowing difficulties involved patients chewing modified release tablets, nurses crushing tablets not authorized to be crushed, mixing medicines together to make them easier to swallow, not flushing tubes between drug administrations and using the wrong syringe to administer medicines down feeding tubes.
Overall, the most common error involved medicines being given at the wrong time, i.e. one hour earlier or later than had been prescribed. Whilst in many cases it is unlikely this would cause any harm, it did include 18 of 49 doses of anti-Parkinson medication being given over an hour late, which could have led to patients with Parkinson’s not having their symptoms adequately controlled and being unable to move, get out of bed or walk down a corridor.
Says Professor David Wright, University of East Anglia who supervised the research: “Whilst the level of errors in patients without swallowing difficulties was no different to that seen by other researchers, it is very apparent that patients with swallowing difficulties seem to be at greater risk of medication administration errors and therefore systems need to be reviewed to improve the quality of their care. Patients should be assessed on their ability to swallow their medication when first admitted to hospital. The results of this study have helped us to pilot new approaches in one of the trusts where observations took place to improve communication between nurses, pharmacists and doctors.”
Daiga Heisters, Head of Professional Engagement and Education at Parkinson's UK, commented: “It's vitally important that people with Parkinson's get their medication on time, every time and we know this can be a particular problem they are admitted to hospital. If people with Parkinson's don't get their medication on time, their symptoms become uncontrolled and their hospital stay is extended. In some cases, this can cause a lasting negative effect on their Parkinson's symptoms.
Our ‘Get it on time’ campaign aims to raise awareness of this issue amongst healthcare professionals and we welcome any initiative which will help people with Parkinson's to get their medication on time.”
Summary of the Research Findings
• 2129 drug administrations observed
• 65 nurse-led medicine administration rounds were openly observed and recorded by the researchers on care-of-the-elderly and stroke wards.
• 34% of the 625 patients observed had swallowing difficulties
• 817 drug administrations involved medication errors
• 170 patients without swallowing difficulties and 133 patients with swallowing problems experienced at least one medication error
• 36 of the 50 patients with an enteral feeding tube experienced at least one error
• 36.7% of anti-Parkinson medication was given over an hour late
Summary of medication errors in patients with swallowing difficulties
• 54.3% Medication given at the wrong time
• 19.8% Wrong preparation
• 9.6% Wrong form
• 6.7% Drug not given
• 2.2% Wrong dose
• 0.7% Wrong drug
• 0.3% Extra dose
www.parkinsons.org.uk
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