A prospective risk assessment of informal carers’ medication administration errors within the domiciliary setting

Abstract

Increasingly, medication is being administered at home by family and friends of the care-recipient. This study aims to identify and analyse risks associated with potential drug administration errors made by informal carers at home. We mapped medication administration at home with a multidisciplinary team that included carers, health care professionals and patients. Evidence-based risk-analysis methodologies were applied: Healthcare Failure Modes and Effect Analysis (HFMEA), Systematic Human Error Reduction and Prediction Analysis (SHERPA) and Systems-Theoretic Accident Model and Processes (STAMP). The process of administration comprises seven sub-processes. Thirty-four possible failure modes were identified and six of these were rated as high risk. These highlighted that medications may be given with a wrong dose, stored incorrectly, not discontinued as instructed, not recorded, or not ordered on time, and often caused by communication and support problems. Combined risk analyses contributed unique information helpful to better understand the medication administration risks and causes within homecare.

Practitioner Summary: Increasingly, medication is being administered at home by family and friends of the care-recipient. This study identifies risks associated with potential drug administration errors made by informal carers at home through consensus-based quantitative techniques. The different analyses contribute unique information helpful to better understand the administration risks and causes.

Keywords:

• Patient safety
• medication errors
• HFMEA, SHERPA, risk assessment

Acknowledgement

We would like to acknowledge and thank all of our team members, particularly: Ms Navila Chaudhry, Ms Fran Husson, Ms Judith Demello, Dr Prem Chana, Dr Susy Long, Mr Mahmood Ali, Ms Hedwiga Lehman, and Ms Margaret Turley. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Sevdalis’ research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust. Sevdalis is a member of King’s Improvement Science, which is part of the NIHR CLAHRC South London and comprises a specialist team of improvement scientists and senior researchers based at King’s College London. Its work is funded by King’s Health Partners (Guy’s and St Thomas’ NHS Foundation Trust, King’s College Hospital NHS Foundation Trust, King’s College London and South London and Maudsley NHS Foundation Trust), Guy’s and St Thomas’ Charity, the Maudsley Charity and the Health Foundation.

Notes

1. This was not relevant because insulin injection devices used by patients and carers do not allow for incomplete administration, and would be administered directly by the carer in this case.