Drug supply in in-patient nursing care facilities: reasons for irregularities in quality reviews

Background: Quality checks of the independent German Health Insurance Medical Service in in-patient nursing care facilities pursuant to Articles 114 et seqq. SGB XI [11th Book of the Social Code] also comprise the Pflegerische Medikamentenversorgung (PMV) [drug supply by nursing personnel]. Irregularities are described in quality reports in the reviewer’s own words. This investigation was intended to categorise the reasons for the above irregularities. Methods: The bases for the examination are the reports of quality checks of all of in-patient nursing care facilities conducted in 2014 (regular quality checks) in Hamburg and Schleswig-Holstein (N = 671), in which the PMV was examined for 5 742 randomly selected residents. Results: With regard to the documentation, inexplicable drug intakes (5.8 %) were found most frequently, followed by missing information on dosages and application provisions (0.8 % each), which were registered as irregularities at the residents. In the documentation of on-demand medication, insufficient indication data (3.2 %), missing daily maximum dosages (0.8 %) and missing single doses (0.6 %) were most commonly ascertained. The most frequent reasons for medication handling irregularities for the residents were false positioning (6.0 %), missing and respectively false data on consumption and on when the medical packaging was opened (3.5 %), as well as medication not directly administered using the blister (0.7 %). As for subordinate classifications of false positioning, incorrect dosages were revealed most often, followed by drugs with an exceeded expiry date and by out-of-stock drugs. Systematic patient-related factors with influence on PMV could not be determined. Conclusions: The extent of the irregularities and their type prompt a further increase in the efforts to improve the quality of nursing care facilities. The results can be used as a basis for designing specific initiatives to improve the PMV.