Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
NIHR Greater Manchester Patient Safety Translational Research Centre (GM PSTRC), Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, United Kingdom.
PLoS One. 2020 Feb 6;15(2):e0228868. doi: 10.1371/journal.pone.0228868. eCollection 2020.
Limited evidence concerning the burden and predictors of omitted medication doses within mental health hospitals could severely limit improvement efforts in this specialist setting. This study aimed to determine the prevalence, nature and predictors of omitted medication doses affecting hospital inpatients in two English National Health Service (NHS) mental health trusts.
Over 6 data collection days trained pharmacy teams screened inpatient prescription charts for scheduled and omitted medication doses within 27 adult and elderly wards across 9 psychiatric hospitals. Data were collected for inpatients admitted up to two weeks prior to each data collection day. Omitted doses were classified as 'time critical' and 'preventable' based on established criteria. Omitted dose frequencies were presented with 95% confidence intervals (CI). Multilevel logistic regression analyses determined the predictors of omitted dose occurrence, with omission risks presented as adjusted odds ratios (OR) with 95% CI.
18,664 scheduled medication doses were screened for 444 inpatients and 2,717 omissions were identified, resulting in a rate of 14.6% (95% CI 14.1-15.1). The rate of 'time critical' omitted doses was 19.3% (95% CI 16.3-22.6%). 'Preventable' omitted doses comprised one third of all omissions (34.5%, 930/2694). Logistic regression analysis revealed that medicines affecting the central nervous system were 55% less likely to be omitted compared to all other medication classes (9.9% vs. 18.8%, OR 0.45 (0.40-0.52)) and that scheduled doses administered using non-oral routes were more likely to be omitted compared the oral route (inhaled OR 3.47 (2.64-4.57), topical 2.71 (2.11-3.46), 'other' 2.15 (1.19-3.90)). 'Preventable' dose omissions were more than twice as likely to occur for 'time critical' medications than non-time critical medications (50.4% vs. 33.8%, OR 2.24 (1.22-4.11)).
Omitted medication doses occur commonly in mental health hospitals with 'preventable' omissions a key contributor to this burden. Important targets for remedial intervention have been identified.
精神卫生医院中漏服药物剂量的负担和预测因素的证据有限，这可能严重限制在这一专科环境中进行改善的努力。本研究旨在确定在英格兰国民保健署（NHS）的两家精神卫生信托机构的 9 家精神病院中，27 个成人和老年病房内，影响住院患者的漏服药物剂量的发生率、性质和预测因素。
在 6 个数据收集日期间，经过培训的药剂团队在 27 个成人和老年病房内筛查了 27 个成人和老年病房的住院患者的预定和漏服药物剂量，这些病房共涉及 9 家精神病院。数据是为在每个数据收集日前两周内入院的患者收集的。根据既定标准，漏服剂量被归类为“时间关键”和“可预防”。漏服剂量的频率以 95%置信区间（CI）呈现。多水平逻辑回归分析确定了漏服剂量发生的预测因素，漏服风险以调整后的比值比（OR）和 95%CI 呈现。
为 444 名住院患者筛查了 18664 个预定药物剂量，共发现 2717 个漏服剂量，漏服率为 14.6%（95%CI 14.1-15.1）。“时间关键”漏服剂量的比例为 19.3%（95%CI 16.3-22.6%）。“可预防”漏服剂量占所有漏服剂量的三分之一（34.5%，930/2694）。逻辑回归分析显示，与所有其他药物类别相比，影响中枢神经系统的药物漏服的可能性低 55%（9.9%比 18.8%，OR 0.45（0.40-0.52）），而非口服途径给药的预定剂量更有可能漏服（吸入剂 OR 3.47（2.64-4.57），局部用药 OR 2.71（2.11-3.46），“其他” OR 2.15（1.19-3.90））。“时间关键”药物的“可预防”漏服剂量发生的可能性是“非时间关键”药物的两倍多（50.4%比 33.8%，OR 2.24（1.22-4.11））。
精神卫生医院中经常发生漏服药物剂量的情况，“可预防”的漏服是造成这种负担的一个关键因素。已经确定了重要的补救干预目标。
