Audit of missed or delayed antimicrobial drugs

Area of Science:

• Patient Safety
• Medication Management
• Antimicrobial Stewardship

Background:

• Omitted and delayed medication doses continue to be a significant patient safety concern, despite previous reports and awareness initiatives.
• The Francis report underscored the potential impact of medication errors on patient care, necessitating further investigation into their occurrence.

Purpose of the Study:

• To investigate the incidence and patterns of omitted antimicrobial doses through a multicentre point-incident collaborative audit.
• To identify the extent to which antimicrobial doses are omitted and to inform targeted interventions for improvement.

Main Methods:

• A multicentre point-incident collaborative audit was conducted.
• Patient records for 6,062 individuals, encompassing 21,825 prescribed antimicrobial doses, were reviewed.

Main Results:

• A total of 13% of all prescribed antimicrobial doses were found to be omitted.
• While some omissions may be clinically justified, a significant proportion may occur without acceptable reason, requiring organizational attention.

Conclusions:

• Sustained improvements in medication safety require national initiatives, robust local nursing leadership, and multidisciplinary collaboration.
• The study provides tools and insights that can assist healthcare organizations in addressing omitted medication doses and enhancing patient care.