M D Nettleman1, M J Bock. 1. Department of Internal Medicine, Medical College of Virginia, Richmond 23298, USA.
Abstract
OBJECTIVE: To identify determinants of missed medication doses in hospitalized patients. DESIGN: A prospective study of 63,031 medication doses was performed. Missed doses were detected through active surveillance. To analyze the potential impact of missed antibiotic doses, we performed a retrospective cohort study of adults with bacterial meningitis. SETTING: A general medical ward and an intensive-care unit in a tertiary-care hospital. PATIENTS: Adult inpatients. RESULTS: There were 906 missed doses (1.4% of all doses). The risk of missing a dose increased directly with the number of daily doses per patient (P<.01). An individual dose was more likely to be missed if the medication was short-acting than if it was long-acting (odds ratio, 1.4; 95% confidence interval, 1.2 to 1.6). Antimicrobials were the most frequently ordered short-acting agents and the most frequently missed class of drug. Patient absences from the floor were common, but only 3% of missed doses occurred during a scheduled absence. A survey revealed that nurses thought missed doses were the predictable result of a system involving multiple personnel and procedural steps. Missed doses were not associated with increased mortality in the cohort study. CONCLUSIONS: Missed doses correlated strongly with the number of daily doses. Efforts to decrease missed doses should focus on minimizing the number of daily doses and streamlining the administration system.
OBJECTIVE: To identify determinants of missed medication doses in hospitalized patients. DESIGN: A prospective study of 63,031 medication doses was performed. Missed doses were detected through active surveillance. To analyze the potential impact of missed antibiotic doses, we performed a retrospective cohort study of adults with bacterial meningitis. SETTING: A general medical ward and an intensive-care unit in a tertiary-care hospital. PATIENTS: Adult inpatients. RESULTS: There were 906 missed doses (1.4% of all doses). The risk of missing a dose increased directly with the number of daily doses per patient (P<.01). An individual dose was more likely to be missed if the medication was short-acting than if it was long-acting (odds ratio, 1.4; 95% confidence interval, 1.2 to 1.6). Antimicrobials were the most frequently ordered short-acting agents and the most frequently missed class of drug. Patient absences from the floor were common, but only 3% of missed doses occurred during a scheduled absence. A survey revealed that nurses thought missed doses were the predictable result of a system involving multiple personnel and procedural steps. Missed doses were not associated with increased mortality in the cohort study. CONCLUSIONS: Missed doses correlated strongly with the number of daily doses. Efforts to decrease missed doses should focus on minimizing the number of daily doses and streamlining the administration system.
Authors: Anthony M Nicasio; Jürgen B Bulitta; Thomas P Lodise; Rebecca E D'Hondt; Robert Kulawy; Arnold Louie; George L Drusano Journal: Antimicrob Agents Chemother Date: 2011-11-14 Impact factor: 5.191
Authors: David Limón; Claire Jiménez-Newman; Mafalda Rodrigues; Arántzazu González-Campo; David B Amabilino; Ana C Calpena; Lluïsa Pérez-García Journal: ChemistryOpen Date: 2017-07-17 Impact factor: 2.911