At least one omitted dose was identified in 25 (58%) non-SAM patients, compared to 23 (54%) SAM patients. Within the non-SAM group, the omissions as a percentage of total prescribed medicines was 13% (108/867), compared to 9% (73/823) in SAM. These differences were statistically significant (p < 0.05; chi-squared tests). The trend of reasons for omission was the same in both groups: “Patient refused” >”No reason given” > “Omitted for clinical reasons” >
“Drug unavailable.” Fifty-one percent in the SAM and 41% in the non-SAM group refused to take their medicines. SGI-1776 datasheet “Drug unavailable” accounted for <10% in both groups, with omissions in the non-SAM group being double that of the SAM group. The pharmacological pattern of omission was different in both groups: SAM – Analgesics (57%)>Laxatives (40%)> Antiemetics (3%); and non-SAM – Laxatives (39%), Other (39%)>Analgesics (18%)>Antiemetics ALK cancer (4%). Omissions for clinical reasons were twice as much in the non-SAM group than in the SAM group, suggesting that clinical judgement by nurses is an important consideration. Significantly
fewer omitted doses occurred in the SAM group (9%, v 13% in non-SAM), indicating that patients are perhaps more likely to take their prescribed medicines promptly when they are responsible for self-administration. The closeness of the results between both groups can be accounted for by Pharmacy’s one-stop dispensing approach and SAM packs being readily available on wards for prompt discharge. This is buttressed by the overall <10% “Drug unavailable” reason for omission. The most common classes of drugs omitted were analgesics, laxatives and anti-emetics, often prescribed on an “as required” basis. Prescribers should be encouraged to place these on the “as required” side of drug charts. The relatively high Resveratrol numbers of the “Other” class in the non-SAM group is a concern, as it includes critical medicines with greater potential for harm. This warrants further investigation.
1. National Patient Safety Agency. Rapid Response Report NPSA/2010/RRR009. Reducing harm from omitted and delayed medicines in hospital. NPSA [Internet]. 2010 Feb 23 [cited 2013 Dec 07]. Available from: http://www.nrls.npsa.nhs.uk/alerts/?entryid45=66720 2. National Prescribing Centre. Self-Administration of Medicines. [Internet]. 2007 [cited 2013 Dec 09]. Available from: http://www.npc.nhs.uk/patients_medicines/self_admin/resources/5mg_sam.pdf R. Brophy, M. Mallet, J. Crowe, D. Skirrow, G. Wynn, J. Vaughan Royal United Hospital NHS Trust, Bath, UK In 2007 the National Patient Safety Agency issued an alert highlighting anticoagulants as one of the medicines most commonly associated with harm events or admission to hospital (1). Using improvement techniques such as PDSA cycles of change and testing we have consistently shown a reduction in the number of patients with an INR greater than 6.