Missed medication doses in hospitalised patients: a descriptive account of quality improvement measures and time series analysis

OBJECTIVE: To investigate the changes in overdue doses rates over a 4-year period in an National Health Service (NHS) teaching hospital, following the implementation of interventions associated with an electronic prescribing system used within the hospital. DESIGN: Retrospective time-series analysis of weekly dose administration data. SETTING: University teaching hospital using a locally developed electronic prescribing and administration system (Prescribing, Information and Communication System or PICS) with an audit database containing details on every drug prescription and dose administration. PARTICIPANTS: Prescription data extracted from the PICS database. INTERVENTION(S): Four interventions were implemented in the Trust: (i) the ability for doctors to pause medication doses; (ii) clinical dashboards; (iii) visual indicators for overdue doses and (iv) overdue doses Root Cause Analysis (RCA) meetings and a National Patient Safety Agency (NPSA) Rapid Response Alert. MAIN OUTCOME MEASURE(S): The percentage of missed medication doses. RESULTS: Rates of both missed antibiotic and non-antibiotic doses decreased significantly upon the introduction of clinical dashboards (reductions of 0.60 and 0.41 percentage points, respectively), as well as following the instigation of executive-led overdue doses RCA meetings (reductions of 0.83 and 0.97 percentage points, respectively) and the publication of an associated NPSA Rapid Response Alert. Implementing a visual indicator for overdue doses was not associated with significant decreases in the rates of missed antibiotic or non-antibiotic doses. CONCLUSIONS: Electronic prescribing systems can facilitate data collection relating to missed medication doses. Interventions providing hospital staff with information about overdue doses at a ward level can help promote reductions in overdue doses rates.