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A multisite analysis of missed doses of antibiotics administered in hospital care
  1. T Carruthers1,
  2. C Curtis2,
  3. J Marriott3,
  4. D Ray3,4,
  5. A Slee3
  1. 1Department of Pharmacy, Heart of England NHS Foundation Hospital, Birmingham, UK
  2. 2Department of Pharmacy, Burton Hospitals NHS Foundation Hospital, Burton-on-Trent, UK
  3. 3Department of Pharmacy, School of Clinical & Experimental Medicine, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
  4. 4Department of Informatics and Patient Administration, University Hospitals Birmingham NHS Foundation Hospital, Birmingham, UK
  1. Correspondence to Professor J Marriott, Pharmacy Department, School of Clinical & Experimental Medicine, College of Medical & Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK; j.f.marriott{at}bham.ac.uk

Abstract

Objectives The study aimed to quantify the incidence of missed antibiotic doses in acute hospitals and identify the underlying reasons using data from electronic prescribing and medicines administration systems (EPMAS), thus establishing the feasibility of determining a minimal acceptable range for missed antibiotic doses.

Methods Prescribing and administration data for antimicrobials were extracted from three hospital EPMAS (1 April 2010–31 March 2011). Data transfer protocols were developed and context mapping undertaken to ensure consistent analysis and interpretation. Total and missed numbers of antibiotic doses were calculated. The top 20 prescribed antibiotics were determined and the reasons for missed antibiotic doses were recorded.

Results A data set of 1 157 576 antibiotic administration events was compiled. The percentage of missed antibiotic doses ranged from 5.90% to 10.26% of the total. The percentage use of the ‘Medicine unavailable’ reason for missed antibiotic doses was a very small proportion of the total numbers of antibiotic doses prescribed (range 0.64–0.98%).

Conclusions This study has demonstrated that large data sets from different EPMAS can be used to quantify the incidence of missed antibiotic doses in acute hospitals. It is proposed that the numbers of ‘Nil By Mouth’ and ‘appropriate clinical reasons’ for dose omission provide an estimate of the maximum proportion of valid missed antibiotic doses within any hospital (range 0.3–4.6% of total antibiotic doses prescribed), so it is suggested that the acceptable level of missed antibiotics should be approximately 5% of the total number of doses intended. Active intervention by senior hospital management appears to lead to the reduction in numbers of missed antibiotic doses. Medicines supply failure was not a significant reason for missed antibiotic administration.

  • antibiotic
  • missed dose
  • electronic prescribing
  • administration
  • hospital

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