title: Non-therapeutic omission of medications in acutely ill patients.
abstract: OBJECTIVE
  To examine documentation of medication administration in medical and surgical patients.
  
  
  OBJECTIVE
  (1) Determine the point prevalence of non-therapeutic medication omissions; (2) identify documented reasons for non-therapeutic medication omissions; (3) examine the relationship between length of stay and medication omissions; and (4) explore the impact of outlier status (e.g. medical patients managed on surgical wards) on medication administration.
  
  
  BACKGROUND
  Acutely ill patients are particularly sensitive to health care errors. We previously identified a 26% rate of non-therapeutic medication omissions in patients admitted unexpectedly to intensive care unit (ICU) from medical and surgical wards.
  
  
  METHODS
  A point prevalence survey of 162 medical and surgical patients across four sites in the South West of England.
  
  
  METHODS
  Data collected included: all instances of, and reasons for, non-therapeutic medication omission. We also recorded whether the patient was an 'outlier' and examined nursing documentation where no reason for medication omission was given on the drug chart.
  
  
  RESULTS
  The number of patients who missed at least one medication was high across all sites (n = 129/162; 79.6%, range 60-88%), with a total of 1077 doses omitted. Patients who were outliers (e.g. surgical patients on a medical ward) were more likely to miss medications (100% versus 74%, p < 0.001). The most common missed medications were analgesia and anti-inflammatory drugs (28%, 299/1077); 203 of these were due to patient refusal.
  
  
  CONCLUSIONS
  The extent of medications omitted for non-therapeutic reasons in medical and surgical patients is of concern. None were recorded as an adverse drug event; however, the extent of omitted or refused medications suggests the need for a review of prescribing and drug administration processes. These findings have important implications for the role of ICU outreach and liaison services, for example, including medication management in the monitoring of patients pre/post-ICU admission and support/education provided for ward staff.
  
  
  CONCLUSIONS
  Detailed analysis of medication records suggests a number of areas of medication administration that would benefit from review.
authors.affiliation: School of Nursing and Community Studies, University of Plymouth, Plymouth, UK.
authors.forename: Siobhan
authors.initials: S
authors.lastname: Warne
authors.forename: Ruth
authors.initials: R
authors.lastname: Endacott
authors.forename: Helen
authors.initials: H
authors.lastname: Ryan
authors.forename: Wendy
authors.initials: W
authors.lastname: Chamberlain
authors.forename: Julie
authors.initials: J
authors.lastname: Hendry
authors.forename: Carole
authors.initials: C
authors.lastname: Boulanger
authors.forename: Nicola
authors.initials: N
authors.lastname: Donlin
mesh_terms: D000208:Acute Disease / Q000628:therapy; D016009:Chi-Square Distribution; D003266:Continuity of Patient Care / Q000458:organization & administration; D003422:Critical Care / Q000458:organization & administration; D004282:Documentation / Q000706:statistics & numerical data*; D004739:England; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008508:Medication Errors / Q000451:nursing / Q000706:statistics & numerical data; D009042:Motivation; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D009737:Nursing Records / Q000706:statistics & numerical data*; D016311:Outliers, DRG / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D012308:Risk Management; D018709:Statistics, Nonparametric; D016312:Treatment Refusal / Q000706:statistics & numerical data