Drug administration errors in an institution for individuals with intellectual disability: an observational study

Area of Science:

• Healthcare Quality and Safety
• Medication Management
• Intellectual Disability Care

Background:

• Medication errors pose significant risks, particularly during the drug administration stage.
• Non-alert patients, often found in intellectual disability (ID) institutions, lack the capacity to act as a final safeguard against errors.
• Understanding drug administration error frequency and determinants is crucial for patient safety in ID settings.

Purpose of the Study:

• To determine the frequency of drug administration errors in individuals with intellectual disability (ID).
• To identify specific factors (determinants) associated with these administration errors.
• To inform strategies for reducing medication errors in ID care environments.

Main Methods:

• An observational study using 'disguised observation' was conducted in a Dutch institution for 2500 individuals with ID.
• Five units across different towns were selected, with drug administrations observed for two weeks in each.
• A total of 953 drug administrations to 46 patients were observed, employing a case-control design to identify error determinants.

Main Results:

• A significant frequency of drug administration errors was observed, ranging from 22.4% to 25.4% (including wrong time errors).
• Key determinants included specific administration routes (oral by feeding tube, inhalation), care unit types (adult full-time care, children daytime care), and the absence of a distribution robot.
• None of the identified errors were reported through the institution's voluntary reporting system.

Conclusions:

• Drug administration errors are prevalent in institutions for individuals with intellectual disability (ID).
• Identified determinants provide targets for interventions to enhance medication safety.
• The lack of reporting highlights a gap in current safety monitoring systems within these institutions.