Medicines-related incidents in Care Homes within the United Kingdom: a scoping review

Abstract

Introduction: In 2006, the Commission for Social Care Inspection stated that nearly 50% of the care homes for older people and younger adults providing 210,000 places for residents were not meeting the minimum standards in relations to the safe use of medicines1. In 2018, the Care Quality Commission in England reported that 20% of residential homes and 28% of nursing homes were rated “inadequate” or “requires improvement”2. A literature review was undertaken. Aim: To identify the evidence-based information on medicines-related incidents defined as any deviation between the medicines prescribed and that administered in care homes and the quality improvement processes.
Methods: The primary author undertook two parallel database searches, focussed on the frequency and root cause of medicines incidents and medicines audit and improvement within care homes using Embase, MHIC and Scopus. Inclusion criteria: English language; UK published between 2008 and 2018. Exclusion criteria: letters, opinion pieces, editorials and case reports. Figure 1 summarises the process. Due to the spectrum of documents the closest matching Critical Appraisal Skills
Program assessment tools were used to assesses the quality of each of the publications.
Results: 1640 documents were identified and twenty-four were analysed. Three studies identified an average medicines-related incident rate (incident per dose intended for administration on the medicines administration record) of 7.1% and 8.4%, and two reported an average rate of 1.2% and 36.7%. Two studies reported variations in allergy record and the variation of medicines errors. Two explored service provision and gaps contributing to medicines incidents. Two reports looked at improving transfer of care to and support within care homes and one that considered improvement to “when required” care plans. One study
described variation between care home and GP records. One study explored staff awareness of medicines incidents. Two summarised inspections by regulators, whilst seven made recommendations or proposed solutions to reduce the rate of medicines-related incidents. These recommendations included: adopt best practice, improve oversight by commissioners and further research.
Conclusions: Evidence-based information on medicines-related incidents rates in care homes is available from published studies and grey literature, but not described in a consistent way. Even if some improvements were implemented (medicines trolley design, medicines reconciliation on the transfer of care), there are no descriptionsof the evaluation of the effectiveness and cost-effectivenessof these tools, improvements or solutions. The main limitation of this review is the use of abstracts
and grey literature.