Towards improving dose administration aid supply: a quality improvement intervention aimed at reducing dispensing errors
- 474 Downloads
Background There is a risk that medicines can be dispensed into dose administration aids (DAAs), inaccurately or unsuitably. Quality improvement interventions (QIIs) may target this pharmacy medicine supply service and reduce the occurrence of these dispensing errors. In turn, medicine administration can improve in nursing homes (NHs) that use these devices. Objective To develop, introduce and evaluate the potential of a QII to improve DAA medicine supply. Setting Fourteen Victorian community pharmacies and 45 NHs. Methods A QII was developed using findings from three focus groups with 13 participants involved with DAAs at community pharmacies and NHs. The intervention was introduced to community pharmacies and NHs via a pharmacist-facilitated education session; attendees completed an evaluation questionnaire. Main outcome measure Potential usefulness and effectiveness of the QII at improving DAA supply and reducing dispensing errors. Results The QII was titled: ‘Be alert and work together for medicine safety, DAA incident awareness toolkit’. Four-hundred and thirty-five questionnaires were returned (85.0 % response rate). Respondents believed the intervention had the potential to improve pharmacy medicine supply or NH medicine administration involving DAAs ‘very’ (47.3 % of responses) or ‘extremely well’ (23.4 %). The intervention had the potential to reduce the occurrence of DAA dispensing errors ‘very’ (49.6 %) or ‘extremely well’ (20.5 %). Conclusion A stakeholder informed QII was perceived to have the potential to improve DAA medicine supply from community pharmacies to NHs and reduce the occurrence of dispensing errors found within them. Future quantitative evaluation of the intervention is required.
KeywordsAustralia Clinical interventions Drug administration schedule Drug packaging Medication errors Medication systems Older adults Pharmacy interventions
The authors wish to thank Kerry Murphy and Souhiela Fakih for taking notes during the focus groups.
Conflicts of interest
- 1.Roughead EE, Semple SJ. Medication safety in acute care in Australia: where are we now? Part 1: a review of the extent and causes of medication problems 2002–2008. Aust N Z Health Policy. 2009;6(18):1–12.Google Scholar
- 3.Flynn EA, Barker KN, Berger BA, Lloyd KB, Brackett PD. Dispensing errors and counseling quality in 100 pharmacies. J Am Pharm Assoc (2003). 2009;49(2):171–80.Google Scholar
- 4.Flynn EA, Barker KN, Carnahan BJ. National observational study of prescription dispensing accuracy and safety in 50 pharmacies. J Am Pharm Assoc (Wash). 2003;43(2):191–200.Google Scholar
- 10.Teinila T, Gronroos V, Airaksinen M. Survey of dispensing error practices in community pharmacies in Finland: a nationwide study. J Am Pharm Assoc (2003). 2009;49(5):604–10.Google Scholar
- 12.Gilmartin JFM, Hussainy SY, Marriott JL. Medicines in Australian nursing homes: a cross-sectional observational study of the accuracy and suitability of re-packing medicines into pharmacy supplied dose administration aids. Res Soc Adm Pharm. 2013:1–8. Epub doi:http://dx.doi.org/10.1016/j.sapharm.2013.01.002 [Epub ahead of print].
- 15.Hussainy SY, Marriott JL, van Koeverden PM, Gilmartin JFM. How accurate are manually prepared dose administration aids in residential aged care facilities? A pilot investigation. Aust Pharmacist. 2012;31(4):320–5.Google Scholar
- 16.Roberts MS, Lentile C, Geoffrey L, Stokes J, Doran C, Hendry M, et al. Effectiveness and cost effectiveness of dose administration aids (DAAs) final report [online]. Quality Medication Care Pty Ltd, University of Queensland, Princess Alexandra Hospital, Australian Government Department of Health and Ageing, Pharmacy Guild of Australia; 2004. Available from: http://beta.guild.org.au/uploadedfiles/Research_and_Development_Grants_Program/Projects/2002-519_fr.pdf. Accessed May 2013.
- 20.Martin B, King D. Who cares for older Australians? A picture of the residential and community based aged care workforce 2007 [online]. Commonwealth of Australia; 2008. Available from: http://www.health.gov.au/internet/publications/publishing.nsf/Content/CA25774C001857CACA257512000423CB/$File/who%20cares.pdf. Accessed May 2013.Google Scholar
- 24.Pharmaceutical Society of Australia. Appendix 5: Examples of medicines which should not be packed in DAA. Pharmaceutical Society of Australia; 2007. Available from: http://www.psa.org.au/supporting-practice/professional-practice-standards/dose-administration-aids-service. Accessed May 2013.
- 26.Pharmaceutical Defence Limited, Australian Journal Of Pharmacy. Guide to good dispensing. Pharmaceutical Defence Ltd; 2010. Available from: http://www.pdl.org.au/publications/gtgd. Accessed May 2013.
- 27.Australian Pharmaceutical Advisory Council. Guiding principles for medication management in the community. Canberra Commonwealth of Australia; 2006. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/23D9459ECD60326FCA257391001C6CFF/$File/booklet.pdf. Accessed May 2013.
- 28.Pharmaceutical Society of Australia. Professional practice standards. Australian Capital Territory: Pharmaceutical Society of Australia; 2010. Available from: http://www.psa.org.au/download/standards/professional-practice-standards-v4.pdf. Accessed May 2013.
- 29.Ryan M, Huxhagen K, Jackson J, Kardachi G, Stokes J, Tsucalas D. Guidelines and standards for pharmacists—Dose Administration Aids Service. Pharmaceutical Society of Australia; 2007. Available from: http://www.psa.org.au/download/community-pharmacy-agreements/dose-administration-aids/dose-administration-service-guidelines.pdf. Accessed May 2013.
- 30.Pharmacy Board of Australia. Guidelines on specialised supply arrangements. Pharmacy Board of Australia; 2012. Available from: http://www.pharmacyboard.gov.au/Codes-Guidelines.aspx. Accessed May 2013.
- 31.HDG Consulting Group. Resource kit to enable implementation of the APAC guidelines for medication management in residential aged care facilities. Department of Human Services; 2006. Available from: http://www.health.vic.gov.au/dpcs/downloads/medication/resource_kit_apac.pdf. Accessed May 2013.
- 32.Australian Pharmaceutical Advisory Council. Guidelines for medication management in residential aged care facilities. Canberra: Australian Pharmaceutical Advisory Council; 2002. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/57005FFD9007A01FCA256F1800468FE6/$File/resguide.pdf. Accessed May 2013.
- 33.Australian Nursing Federation. ANF guidelines—the use of dose administration aids by nurses; 2008. Available from: http://anf.org.au/documents/policies/G_Dose_Administration_Aids.pdf. Accessed May 2013.
- 34.Australian Nursing Federation. ANF position statement—the use of dose administration aids by nurses; 2011. Available from: http://anf.org.au/documents/policies/PS_Dose_administration_aids.pdf. Accessed May 2013.
- 35.Saini B, Smith L, Armour C, Krass I. An educational intervention to train community pharmacists in providing specialized asthma care. Am J Pharm Educ. 2006;70(5):1–10.Google Scholar