The epidemiology of missed medication doses in hospitalized patients.
OBJECTIVE
To identify determinants of missed medication doses in hospitalized patients.


METHODS
A prospective study of 63,031 medication doses was performed. Missed doses were detected through active surveillance. To analyze the potential impact of missed antibiotic doses, we performed a retrospective cohort study of adults with bacterial meningitis.


METHODS
A general medical ward and an intensive-care unit in a tertiary-care hospital.


METHODS
Adult inpatients.


RESULTS
There were 906 missed doses (1.4% of all doses). The risk of missing a dose increased directly with the number of daily doses per patient (P<.01). An individual dose was more likely to be missed if the medication was short-acting than if it was long-acting (odds ratio, 1.4; 95% confidence interval, 1.2 to 1.6). Antimicrobials were the most frequently ordered short-acting agents and the most frequently missed class of drug. Patient absences from the floor were common, but only 3% of missed doses occurred during a scheduled absence. A survey revealed that nurses thought missed doses were the predictable result of a system involving multiple personnel and procedural steps. Missed doses were not associated with increased mortality in the cohort study.


CONCLUSIONS
Missed doses correlated strongly with the number of daily doses. Efforts to decrease missed doses should focus on minimizing the number of daily doses and streamlining the administration system.
Nettleman
M D
MD
Department of Internal Medicine, Medical College of Virginia, Richmond 23298, USA.
Bock
M J
MJ
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D015994:Incidence; D008508:Medication Errors / Q000706:statistics & numerical data*; D008510:Medication Systems, Hospital / Q000592:standards*; D016920:Meningitis, Bacterial / Q000188:drug therapy*; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States