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The influence of formulation and medicine delivery system on medication administration errors in care homes for older people
  1. David Phillip Alldred1,
  2. Claire Standage1,
  3. Olivia Fletcher2,
  4. Imogen Savage3,
  5. James Carpenter2,
  6. Nick Barber3,
  7. David Kenneth Raynor1
  1. 1Academic Unit of Medicines Management, School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
  2. 2Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK
  3. 3The School of Pharmacy, BMA House, Tavistock Square, University of London, London, UK
  1. Correspondence to Dr David Phillip Alldred, Academic Unit of Medicines Management, School of Healthcare, Baines Wing, University of Leeds, Leeds LS2 9UT, UK; d.p.alldred{at}


Introduction Older people in care homes are at increased risk of medication errors and adverse drug events. The effect of formulation on administration errors is not known, that is whether the medicine is a tablet or capsule, liquid or device such as an inhaler. Also, the impact on administration errors of monitored dosage systems (MDS), commonly used in UK care homes to dispense tablets and capsules, is not known. This study investigated the influence of formulation and MDS on administration errors.

Methods Administration errors were identified by pharmacists (using validated definitions) observing two drug rounds of residents randomly selected from a purposive sample of UK nursing and residential homes. Errors were classified and analysed by formulation and medicine delivery system.

Results The odds of administration errors by formulation, when compared with tablets and capsules in MDS, were: liquids 4.31 (95% CI 2.02 to 9.21; p=0.0002); topicals/transdermals/injections 19.61 (95% CI 6.90 to 55.73; p<0.0001); inhalers 33.58 (95% CI 12.51 to 90.19; p<0.0001). The odds of administration errors for tablets and capsules not in MDS were double those that were dispensed in MDS (adjusted OR 2.14, 95% CI 1.02 to 4.51; p=0.04).

Conclusions Inhalers and liquid medicines were associated with significantly increased odds of administration errors. Training of staff in safe administration of these formulations needs implementing. Although there was some evidence that MDS reduced the odds of an administration error, the use of MDS impacts on other aspects of medicines management. Because of this, and as the primary topic of our study was not MDS, a prospective trial specifically designed to evaluate the overall impact of MDS on medicine management in care homes is needed.

  • Medication error
  • care homes
  • monitored dosage systems
  • medicine formulation
  • medical error
  • nursing homes

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  • Funding The study was funded by the Patient Safety Research Programme of the Department of Health.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Central Office for Research Ethics Committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.