title: Use of an electronic medication administration record (eMAR) for surveillance of medication omissions: results of a one year study of antimicrobials in the inpatient setting.
abstract: BACKGROUND
  Medication administration omissions (MAO) are usually considered medication errors but not all MAO are clinically relevant. We determined the frequency of clinically relevant MAO of antimicrobial drugs in adult hospitals in Calgary, Alberta, Canada based on electronic medication administration record (eMAR).
  
  
  METHODS
  We examined 2011 data from eMAR records on medical wards and developed a reproducible assessment scheme to categorize and determine clinical relevance of MAO. We applied this scheme to records from 2012 in a retrospective cohort study to quantify clinically relevant MAO. Significant predictors of clinically relevant MAO were identified.
  
  
  RESULTS
  A total of 294,718 dose records were assessed of which 10,282 (3.49%) were for doses not administered. Among these 4903 (1.66% of total); 47.68% of MAO were considered clinically relevant. Significant positive predictors of clinically relevant MAO included inhaled (OR 4.90, 95% CI 3.54-6.94) and liquid oral (OR 1.32, 95% CI 1.18-1.47) route of medication compared to solid oral and irregular dose schedules. Evening nursing shift compared to night shift (OR 0.77 95% CI 0.70-0.85) and parenteral (OR 0.50, 95% CI 0.46-0.54) were negative predictors, The commonest reasons for relevant MAO were patient preference, unspecified reason, administration access issues, drug not available or patient condition.
  
  
  CONCLUSIONS
  Assessment of MAO by review of computer records provides a greater scope and sample size than directly observed medication administration assessments without "observer" effect. We found that MAO of antimicrobials in inpatients were uncommon but were seen more frequently with orally administered antimicrobials which may have significance to antimicrobial stewardship initiatives.
authors: Pharmacy Department, Alberta Health Services, Calgary Zone. Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors: Bruce R
authors: BR
authors: Dalton
authors: Pharmacy Department, Alberta Health Services, Calgary Zone. Calgary, Alberta, Canada.
authors: Deana M
authors: DM
authors: Sabuda
authors: Pharmacy Department, Alberta Health Services, Calgary Zone. Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors: Lauren C
authors: LC
authors: Bresee
authors: O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Synder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors: John M
authors: JM
authors: Conly
mesh_terms: D000280:Administration, Inhalation; D000284:Administration, Oral; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002170:Canada; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data*; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D010564:Personnel, Hospital / Q000523:psychology; D012189:Retrospective Studies
chemical_list: D000890:Anti-Infective Agents