title: Medication administration errors in assisted living: scope, characteristics, and the importance of staff training.
abstract: OBJECTIVE
  To compare rates of medication errors committed by assisted living staff with different training and to examine characteristics of errors.
  
  
  METHODS
  Observation of medication preparation and passes, chart review, interviews, and questionnaires.
  
  
  METHODS
  Stratified random sample of 11 assisted living communities in South Carolina (which permits nonnurses to administer medications) and Tennessee (which does not).
  
  
  METHODS
  All staff who prepared or passed medications: nurses (one registered nurse and six licensed practical nurses (LPNs)); medication aides (n=10); and others (n=19), including those with more and less training.
  
  
  METHODS
  Rates of errors related to medication, dose and form, preparation, route, and timing.
  
  
  RESULTS
  Medication preparation and administration were observed for 4,957 administrations during 83 passes for 301 residents. The error rate was 42% (20% when omitting timing errors). Of all administrations, 7% were errors with moderate or high potential for harm. The odds of such an error by a medication aide were no more likely than by a LPN, but the odds of one by staff with less training was more than two times as great (odds ratio=2.10, 95% confidence interval=1.27-3.49). A review of state regulations found that 20 states restrict nonnurses to assisting with self-administration of medications.
  
  
  CONCLUSIONS
  Medication aides do not commit more errors than LPNs, but other nonnurses who administered a significant number of medications and assisted with self-administration committed more errors. Consequently, all staff who handle medications should be trained to the level of a medication aide.
authors.affiliation: Program on Aging, Disability, and Long-Term Care, Cecil G. Sheps Center for Health Services Research, School of Social Work, Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA. sheryl_zimmerman@unc.edu
authors.forename: Sheryl
authors.initials: S
authors.lastname: Zimmerman
authors.forename: Karen
authors.initials: K
authors.lastname: Love
authors.forename: Philip D
authors.initials: PD
authors.lastname: Sloane
authors.forename: Lauren W
authors.initials: LW
authors.lastname: Cohen
authors.forename: David
authors.initials: D
authors.lastname: Reed
authors.forename: Paula C
authors.initials: PC
authors.lastname: Carder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities / Q000331:legislation & jurisprudence / Q000592:standards / Q000706:statistics & numerical data*; D002983:Clinical Competence / Q000331:legislation & jurisprudence / Q000592:standards; D005161:Facility Regulation and Control / Q000331:legislation & jurisprudence / Q000592:standards; D005260:Female; D006302:Health Services Research / Q000706:statistics & numerical data; D006801:Humans; D007318:Inservice Training / Q000331:legislation & jurisprudence; D008297:Male; D008508:Medication Errors / Q000331:legislation & jurisprudence / Q000451:nursing / Q000517:prevention & control* / Q000706:statistics & numerical data*; D054539:Medication Therapy Management / Q000331:legislation & jurisprudence / Q000592:standards; D008875:Middle Aged; D013022:South Carolina; D013714:Tennessee