Audit of missed or delayed antimicrobial drugs.

Although the National Patient Safety Agency published a Rapid Response Report on reducing harm resulting from omitted or delayed medication in 2010, omitted doses continue to occur frequently. The Francis report raised awareness of the problem and its potential impact on care. This article discusses the findings from a multicentre point-incident collaborative audit, focused on antimicrobials. We reviewed records from 6,062 patients prescribed 21,825 doses of antimicrobials; 13% were affected by omitted doses. Some doses are omitted in patients' best interests, but organisations need to identify those that occur for no acceptable reason and target them as a priority. We need national initiatives, strong local nursing leadership and multidisciplinary engagement to support a range of targeted interventions to achieve effective, sustained improvements. The tools developed from this study may help others to begin tackling this issue.