The Pharmaceutical Journal
Vol 268 No 7187 p274-79
2 March 2002

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The Centre for Medication Error Prevention (www.medication-errors.org.uk)

Giving medicines from patient lockers reduces errors

Pharmacists at the Wirral Hospitals NHS Trust have shown that a re-engineered method for drug administration on hospital wards leads to fewer medicine administration errors by nurses.

Speaking at a meeting on medication errors, Karen Pritchard described a study that compared traditional administration (using a ward medicines trolley) with a re-engineered system (using a bedside locker for each patient's drugs). The meeting was organised by the north west region chief pharmacists group and was held at Alder Hey Children's Hospital in Liverpool last week.

In the traditional system, the medicines trolley contained both ward stock and non-ward stock items. Patients' own drugs were not formally used. In the re-engineered system, patients' own drugs were used after being assessed for suitability by pharmacy staff.

Mrs Pritchard said that the benefits of the re-engineered system — including reduced costs — had been widely published. However, whether the new system was safer was not clear until now.

The pharmacists involved in the study used a disguised observation method to assess what was actually administered by nurses compared with the intended or prescribed medication. Any interventions by the observer were made as late as possible to allow time for the nurses to remedy their own errors.

A baseline error rate of 10 per cent dropped to 2.5 per cent when drugs were administered from patients' own medicine lockers, Mrs Pritchard said. The type of errors that occurred also differed. With the traditional system there were 78 instances of omitted drugs, of which 42 per cent had been available in the trolley but not located. In the re-engineered system, 26 omission errors occurred, with 8 per cent of the omitted drugs being present in the lockers. In addition, approximately 14 per cent of the doses given from the ward trolley were given at the wrong time compared with 6.5 per cent of those given from the medicines locker.

After introducing the system of using patient's own medicines lockers, none of the nurses working on the wards said they would want to revert to the old system.