Dosing errors, wrong medicines

What are the most common medicine self-administration errors?

Pharmacist researchers Dr Ramesh Walpola and Fatma Aldila from the School of Population Health, UNSW have conducted a systematic review to identify types of medicine self-administration errors and their contributing factors among community-dwelling older adults.

Across 11 studies, they found dosing errors were the most frequently reported medicine self-administration errors among individuals aged 50 and over, reported in seven of the studies.

Other errors included missed dose, wrong medicine, duplicity of medicines, incorrect preparation methods, incorrect administration methods, wrong administration route, wrong administration time, wrong frequency, incorrect spacing (time period between doses) and use of expired medicines.

Seven studies identified complex treatment regimens which involved use of multiple medicines as a contributing factor to medicine self-administration errors.

Four studies identified cognitive decline as a contributing factor.

Other factors identified in three studies included lack of knowledge about treatment regimens, negative attitudes and beliefs towards medicines, decline in physical ability, and lack of social support.

The review found that, when lacking social support, older adult patients were more likely to skip medicines.

Multiple chronic conditions, poor collaboration between patients/healthcare professionals and among healthcare professionals, pharmaceutical products and packaging design, and confusion associated with the use of compliance aids were respectively reported in two studies.

Meanwhile limited health literacy, absence of error detection mechanisms and absence of patient education were reported in one study each.

The review also found inappropriate splitting and crushing of sustained-release tablets was a common practice among older adult patients.

“To prevent patient harm, older adult patients need to be informed if medicines they are taking are unsafe to crush or split,” said the researchers.

“Medicine administration strategies, such as methods to help patients swallow pills, should also be shared with older adult patients.”

Medication reviews, including home medicines reviews, may be one solution to the risk of medicine self-administration errors, wrote authors Dr Walpola and Ms Aldila.

However they added that there is no single solution to prevent them as “many medicine self-administration errors occurred because of multiple interactive factors”. 

Future research needs to focus on how pharmacists can better support older adult patients in self-managing their medicines, particularly as more older adults are choosing to live independently for longer, the authors concluded.

This research was published in Research in Social and Administrative Pharmacy

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