Study reveals high level of drug errors in care homes

By Jeremy Dunning on October 6, 2009 in Adults, Residential care

Calls have been made for an overhaul of drug prescribing procedures in care homes after seven out of 10 residents were found to have suffered from medication errors, a study has found.

The government-funded research found people had been given the wrong drug or dose due to inadequate medical data, overworked staff, and poor co-ordination among teams.

The study, led by Professor Nick Barber at the University of London School of Pharmacy, said: “We saw several errors, particularly monitoring errors, which had caused harm or were likely to.

Errors ‘reduce quality of life’

“In addition, many errors would reduce the quality of life and ability to function of residents, such as inadequate treatment of pain, of bowels and of breathing.”

This is despite a government pledge in 2000 to cut the number of drug errors following the publication of a report on medical mistakes.

Antipsychotics concerns

Last year, a report by the all-party parliamentary group on dementia found that up to 105,000 people with dementia in residential care had been wrongly given antipsychotic drugs.

The findings, which appear in the Quality and Safety in Health Care, are based on a random sample of 256 residents in 55 care homes in West Yorkshire, Cambridgeshire, and central London.

Residents suffered variety of errors

Each care home resident was taking an average of eight medicines each. One or more drug errors were made in seven out of 10 (69.5% or 178) cases, with the average number of mistakes just under two for each resident.

The study showed that 94 residents were the victims of dispensing errors, that 57 suffered a total of 116 administration errors, including being given the wrong dose or not being given drugs at all, and 100 people were subject to prescribing errors.

Almost a third of drugs (30%) that should have been monitored for potentially harmful side effects were not monitored.

Staff overworked

The study found a variety of reasons for the errors. Some staff were found to have lacked knowledge of what medicines should be given with food, did not always know how to administer inhalers, did not order sufficient quantities of medication and had interrupted drug rounds but were also often overworked.

There was a lack of knowledge by pharmacy staff of the care homes’ systems.

Among other factors there were issues on the accessibility of doctors, some of whom did not know residents or had insufficient background information on residents’ medical history when prescribing drugs.

Poor joint working

It also noted poor team work between care homes, GP practices, and the pharmacy, poor record keeping, and complicated administrative systems.

The authors noted that care homes were very worried about medication errors and added that “it was clear from the interviews that no one took responsibility for the whole system”.

Communication was another issue, frequently making it difficult to know which drug “any patient should be having.”

The report suggested exploring the idea of a lead GP for each home as well as having one person with overall responsibility for medicines use in one or more care homes.

Clear care framework needed

John Turk, the chief executive of the National Pharmacy Association said: “Health professionals, including pharmacists are working hard to provide good care, but they need a clear framework in which to operate. We would urge government to ensure local care is better co-ordinated by the NHS and to involve pharmacies in local planning and implementation.”

The English Community Care Association (ECCA), which represents independent care providers, condemned GPs’ lack of engagement with care homes.

Chief executive Martin Green said: “The evidence is clear. There is a problem with the way in which many GPs engage with care homes.

Scandalous abuse

“It is time the Department of Health, strategic health authorities and primary care trusts delivered an end to this scandalous abuse of older people”.

The Care Quality Commission said it was considering the findings of the study and would be discussing it with the DH and other agencies to see what action needed to be taken.

A spokesperson added: “The study comes out at a time when CQC is planning a special review of healthcare for people living in care homes, which is to be carried out in the near future.

Among other things this will look at the contributions made by GPs, other healthcare professionals, care homes, PCTs and councils to aspects of medicines management.”

People with dementia wrongly given drugs, say MPs