Medication Administration Errors in Assisted Living: Scope, Characteristics, and the Importance of Staff Training

• Published in: Journal of the American Geriatrics Society (JAGS) 2011-06, Vol.59 (6), p.1060-1068
• Main Authors: Zimmerman, Sheryl, Love, Karen, Sloane, Philip D., Cohen, Lauren W., Reed, David, Carder, Paula C.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Assisted living facilities; Assisted Living Facilities - legislation & jurisprudence; Assisted Living Facilities - standards; Assisted Living Facilities - statistics & numerical data; Biological and medical sciences; Clinical Competence - legislation & jurisprudence; Clinical Competence - standards; Drug therapy; Facility Regulation and Control - legislation & jurisprudence; Facility Regulation and Control - standards; Female; General aspects; Health participants; Health Services Research - statistics & numerical data; Humans; Inservice Training - legislation & jurisprudence; Male; Medical errors; Medical sciences; medication aides; Medication Errors - legislation & jurisprudence; Medication Errors - nursing; Medication Errors - prevention & control; Medication Errors - statistics & numerical data; Medication Therapy Management - legislation & jurisprudence; Medication Therapy Management - standards; Middle Aged; Miscellaneous; nurses; policy; Public health. Hygiene; Public health. Hygiene-occupational medicine; residential care; self-administration; South Carolina; Tennessee
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2011.03430.x

OBJECTIVES: To compare rates of medication errors committed by assisted living staff with different training and to examine characteristics of errors. DESIGN: Observation of medication preparation and passes, chart review, interviews, and questionnaires. SETTING: Stratified random sample of 11 assisted living communities in South Carolina (which permits nonnurses to administer medications) and Tennessee (which does not). PARTICIPANTS: All staff who prepared or passed medications: nurses (one registered nurse and six licensed practical nurses (LPNs)); medication aides (n=10); and others (n=19), including those with more and less training. MEASUREMENTS: Rates of errors related to medication, dose and form, preparation, route, and timing. RESULTS: Medication preparation and administration were observed for 4,957 administrations during 83 passes for 301 residents. The error rate was 42% (20% when omitting timing errors). Of all administrations, 7% were errors with moderate or high potential for harm. The odds of such an error by a medication aide were no more likely than by a LPN, but the odds of one by staff with less training was more than two times as great (odds ratio=2.10, 95% confidence interval=1.27–3.49). A review of state regulations found that 20 states restrict nonnurses to assisting with self‐administration of medications. CONCLUSION: Medication aides do not commit more errors than LPNs, but other nonnurses who administered a significant number of medications and assisted with self‐administration committed more errors. Consequently, all staff who handle medications should be trained to the level of a medication aide.