The effect of an intervention aimed at reducing errors when administering medication through enteral feeding tubes in an institution for individuals with intellectual disability

• Published in: Journal of intellectual disability research Vol. 53; no. 11; pp. 932 - 938
• Main Authors: Idzinga, J. C., De Jong, A. L., Van Den Bemt, P. M. L. A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.11.2009; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Adult; Artificial feeding; Assistive Technology; At Risk Persons; Biological and medical sciences; Catheters; Community Pharmacy Services; Confidence intervals; Cooperative Behavior; Critical incidents; Drug Therapy; Enteral Nutrition; Error Correction; Error Patterns; Feeding; feeding tube; Female; Foreign Countries; Hospitals; Humans; Inservice Training; Institution therapy. Inpatient treatment; Institutionalization; Institutionalized Persons; Intellectual Disability; Intellectual Disability - nursing; Interdisciplinary Communication; Intervention; Learning disabilities; Male; Medical errors; Medical sciences; medication administration errors; Medication Errors - prevention & control; medication safety; Medication Systems; Mental Retardation; Middle Aged; Modification; Multivariate Analysis; Netherlands; Nurses; Nursing; Outcome Measures; Program Effectiveness; Prospective Studies; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Quality of care; Residential Care; Robotics; Treatments; Netherlands; Europe; Social environment; Handicap; Human; medication safety; Intervention procedure; Medical error; Mental health; Specialized institution; Pharmacotherapy; Feeding tube; Developmental disorder; Mental retardation; Enteral administration; Treatment; Follow up study; Risk factor; Intellectual deficiency; Application method; Safety; medication administration errors; Public health; intellectual disability
• ISSN: 0964-2633; 1365-2788
• DOI: 10.1111/j.1365-2788.2009.01212.x

Background  Previous studies, both in hospitals and in institutions for clients with an intellectual disability (ID), have shown that medication errors at the administration stage are frequent, especially when medication has to be administered through an enteral feeding tube. In hospitals a specially designed intervention programme has proven to be effective in reducing these feeding tube‐related medication errors, but the effect of such a programme within an institution for clients with an ID is unknown. Therefore, a study was designed to measure the influence of such an intervention programme on the number of medication administration errors in clients with an ID who also have enteral feeding tubes. Methods  A before‐after study design with disguised observation to document administration errors was used. The study was conducted from February to June 2008 within an institution for individuals with an ID in the Western part of The Netherlands. Included were clients with enteral feeding tubes. The intervention consisted of advice on medication administration through enteral feeding tubes by the pharmacist, a training programme and introduction of a ‘medication through tube’ box containing proper materials for crushing and suspending tablets. The outcome measure was the frequency of medication administration errors, comparing the pre‐intervention period with the post‐intervention period. Results  A total of 245 medication administrations in six clients (by 23 nurse attendants) have been observed in the pre‐intervention measurement period and 229 medication administrations in five clients (by 20 nurse attendants) have been observed in the post‐intervention period. Before the intervention, 158 (64.5%) medication administration errors were observed, and after the intervention, this decreased to 69 (30.1%). Of all potential confounders and effect modifiers, only ‘medication dispensed in automated dispensing system (“robot”) packaging’ contributed to the multivariate model; effect modification was shown for this determinant. Multilevel analysis using this multivariate model resulted in an odds ratio of 0.33 (95% confidence interval 0.13–0.71) for the error percentage in the post‐intervention period compared with the pre‐intervention period. Conclusions  The intervention was found to be effective in an institution for clients with an ID. However, additional efforts are needed to reduce the proportion of administration errors which is still high after the intervention.