Annals of Long Term Care

Types, Prevalence, and Potential Clinical Significance of Medication Administration Errors in Assisted Living

Heather M. Young, PhD, GNP, Shelly L. Gray, PharmD, MS, Wayne C. McCormick, MD, MPH, Suzanne K. Sikma, PhD, RN, Susan Reinhard, PhD, RN, Linda Johnson Trippett, RNC, MSN, Carol Christlieb, RN, MSN, and Tiffany Allen, BS

OBJECTIVES: To describe the types and potential clinical significance of medication administration errors in assisted living (AL).

DESIGN: Cross-sectional observational study.

SETTING: This study was conducted in 12 AL settings in three states (Oregon, Washington, and New Jersey).

PARTICIPANTS: Participants included 29 unlicensed assistive personnel and 510 AL residents.
MEASUREMENTS: Medication administration observations, chart review, and determination of rates, types, and potential clinical significance of errors using standardized methodology.

RESULTS: Of 4,866 observations, 1,373 errors were observed (28.2% error rate). Of these, 70.8% were wrong time, 12.9% wrong dose, 11.1% omitted dose, 3.5% extra dose, 1.5% unauthorized drug, and 0.2% wrong drug. Excluding wrong time, the overall error rate dropped to 8.2%. Of the 1,373 errors, three were rated as having potential clinical significance.

CONCLUSION: A high number of daily medications are given in AL. Wrong time accounted for the majority of the errors. The bulk of the medications are low risk and routine; to promote optimal care delivery, clinicians need to focus on high-risk medications and residents with complex health problems. J Am Geriatr Soc 2008;56(7):1199-1205.

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Stage 2 Pressure Ulcer Healing in Nursing Homes

Nancy Bergstrom, PhD, RN, Randall Smout, MS, Susan Horn, PhD, William Spector, PhD, Arthur Hartz, MD, PhD, and M. Rhona Limcangco, PhD

OBJECTIVES: To identify resident and wound characteristics associated with Stage 2 pressure ulcer (PrU) healing time in nursing home residents.

DESIGN: Retrospective cohort study with convenience sampling.

SETTING: One hundred two nursing homes participating in the National Pressure Ulcer Long-Term Care Study (NPULS) in the United States.

PARTICIPANTS: Seven hundred seventy-four residents aged 21 and older with length of stay of 14 days or longer who had at least one initial Stage 2 (hereafter Stage 2) PrU.

MEASUREMENTS: Data collected for each resident over a 12-week period included resident characteristics and PrU characteristics, including area when first reached Stage 2. Data were obtained from medical records and logbooks.

RESULTS: There were 1,241 initial Stage 2 PrUs on 774 residents; 563 (45.4%) healed. Median time to heal was 46 days. Initial area was significantly associated with days to heal. Using Kaplan-Meier survival analyses, median days to heal was 33 for small (≤1 cm2), 53 days for medium (>1 to ≤4 cm2), and 73 days for large (>4 cm2) ulcers. Using Cox proportional hazard regression models to examine effects of multiple variables simultaneously, small and medium ulcers and ulcers on residents with agitation and those who had oral eating problem healed more quickly, whereas ulcers on residents who required extensive assistance with seven to eight activities of daily living (ADLs), who temporarily left the facility for the emergency department (ED) or hospital, or whose PrU was on an extremity healed more slowly.

CONCLUSION: PrUs on residents with agitation or with oral eating problems were associated with faster healing time. PrUs located on extremities, on residents who went temporarily to the ED or hospital, and on residents with high ADL disabilities were associated with slower healing time. Interaction between PrU size and place of onset was also associated with healing time. For PrU onset before or after admission to the facility, smaller size was associated with faster healing time.