Measuring non-administration of ordered medications in the pediatric inpatient setting

Medication compliance in inpatient settings shows some significant gaps for adult patients. In pediatric settings prescribing and other administration errors have been studied but missed doses have not been specifically studied in the pediatric inpatient setting. We intended to apply health information technology and data processing methods to study the medication compliance for pediatric patients at our institution.

We collected medication ordering, dispensing, and administration data spanning 42 months (7/1/2010 through 12/31/2013) for pediatric inpatients admitted to a major tertiary pediatric hospital. We analyzed the orders for which either the corresponding administration record was missing or the records indicated non-administration.

There were only 596 medication orders without corresponding administration records, accounting for less than 0.05% of 1.6 Million orders for 56,000 patients. There were 40,999 orders with corresponding administration records indicating non-administration (or less than 3% of all orders). Overall order compliance of the nursing staff was 97.35%, with another 2.6% of orders having a documented reason for non-administration The top two medication classes comprising the missed and non-administered orders were "Alimentary tract and metabolism drugs" and "Nervous system drugs".

Measurement of medication compliance is an important quality measure of patient safety and quality of care. Our study found a small proportion of non-administered medication orders and discovered corresponding reasons illustrating how health information technology can help to measure the quality of the medication process from ordering and dispensing to administration at a major healthcare institution.