Medication errors are reaching dangerous levels in LTC facilities and modern technology can stop this
Patient safety is a top priority for all healthcare facilities, and nursing homes are no exception. Specifically, medication errors have become a growing concern for long-term care providers. Most nursing homes still depend on an antiquated system: paper-based charts and records, including the medication administration record (MAR), that are handwritten for each medication administration event for each resident. And yet the same type of technology—both software and hardware—that is experiencing success in acute care facilities can be just as beneficial, if not more so, in long-term care facilities, where residents need even more frequent med passes, treatments, and attention from nursing staff.
Imagine this familiar sight in the corridors of many long-term care facilities: A paper MAR the size of the New York City yellow pages sits atop a medication cart, as nurses transcribe individual dosage instructions from handwritten records—an inefficient process with no clearly defined workflow that places needless stress on nursing staff. Paper MARs are not inherently designed to reduce medication errors and they have remained unchanged for decades.
Illegible entries can result in medication administration mistakes: A nurse might misread a handwritten note left by a doctor or colleague. Instructions about discontinuing a medication or altering its dosage might not be accurately recorded. If a med pass is delayed when staff must meet an urgent resident need, the paper-based system makes it difficult to ensure that the process resumes seamlessly. The common practice of inserting a straw or bookmark into the MAR during an interrupted med pass certainly does not ensure that it is resumed accurately, nor does it provide peace of mind for staff.
With so many possibilities for error, administrators and directors of nursing cannot be confident that their MARs will pass the scrutiny of the state surveyor. Pharmacies and long-term care providers must reconcile their paper-based MARs at the end of the month to match the drugs that were added or changed since the print date. Incomplete entries or chart “holes” make it difficult to audit medication administration and provide effective quality control. At survey time, these holes can result in fines of roughly $2,500 per incident, according to industry estimates.
This lack of controls and tools to make the med pass process easier and more efficient contribute heavily to adverse drug events (ADEs) in long-term care. In fact, a study published in The American Journal of Medicine concluded that with 1.6 million long-term care residents in the United States, there are 1.9 million ADEs per year.1 More specifically, a 2006 study on the prevention of medication errors by the Institute of Medicine found that:
• Excluding wrong-time errors, omission of an ordered medication is generally the most common type of drug administration error in nursing homes.
• Preventable ADEs run at a rate of 50 per 100-bed nursing home.
• The most common medication administration errors are administering an unauthorized drug (44.8%), omitting a prescribed drug (41.5%), administering the wrong dose (11%), administering via the wrong route (2%), and administering the wrong form (0.4%).