Drug error rate low for assisted living patients

NEW YORK (Reuters Health) - Potentially harmful medication administration errors are very rare in assisted living settings, the result of a study of 12 facilities in three states suggests.

Assisted living facilities are a less expensive alternative to skilled nursing facilities, offering residents more independence and a homier environment. Medication errors are a concern in these settings, lead investigator Dr. Heather M. Young of Oregon Health and Science University in Ashland and her colleagues say, because aides with no licensing or professional training are typically charged with distributing drugs to residents.

To investigate the prevalence of medication errors, the researchers observed 29 unlicensed assistive personnel giving out medications to 510 assisted living residents at facilities in New Jersey, Oregon and Washington. They watched 56 "medication passes," including both day and night shifts, for a total of 4,866 observations.

Young and her team observed 1,373 errors, for an error rate of 28.2 percent. But 70.8 percent of the errors were time-related, meaning a patient didn't get a drug within an hour of the scheduled dosing time. Once time was removed from the analysis, the error rate was 8.2 percent.

Other causes of errors included wrong dose (12.9 percent), skipped dose (11.1 percent), extra dose (3.5 percent), unauthorized drug (1.5 percent) and wrong drug (0.2 percent),Young's team reports in the Journal of the American Geriatrics Society. Only three of the errors observed had potential clinical significance, according to the researchers, and none of the errors were considered "highly likely to cause harm."

None of the time-related errors involved giving medications for which timing was crucial, such as insulin. Because medication is typically given out to assisted living residents twice a day at a standardized time, the researchers say, "a high number of wrong-time errors is not surprising, and given the lack of clinical significance of the errors observed, is probably not a meaningful indicator of quality."

The researchers did find that errors were more likely to occur with riskier medications, like insulin or the blood thinning drug warfarin, which are typically given to patients "in less stable and predictable conditions."

They suggest that prioritizing the administration of high-risk drugs, as well as the care of patients with more complex health issues, could help prevent serous medication errors and improve the quality of care.

SOURCE: Journal of the American Geriatrics Society, July 2008.