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Objective To investigate the changes in overdue doses rates over a 4-year period in an National Health Service (NHS) teaching hospital, following the implementation of interventions associated with an electronic prescribing system used within the hospital. Design Retrospective time-series analysis of weekly dose administration data. Setting University teaching hospital using a locally developed electronic prescribing and administration system (Prescribing, Information and Communication System or PICS) with an audit database containing details on every drug prescription and dose administration. Participants Prescription data extracted from the PICS database. Intervention(s) Four interventions were implemented in the Trust: (i) the ability for doctors to pause medication doses; (ii) clinical dashboards; (iii) visual indicators for overdue doses and (iv) overdue doses Root Cause Analysis (RCA) meetings and a National Patient Safety Agency (NPSA) Rapid Response Alert. Main outcome measure(s) The percentage of missed medication doses. Results Rates of both missed antibiotic and non-antibiotic doses decreased significantly upon the introduction of clinical dashboards (reductions of 0.60 and 0.41 percentage points, respectively), as well as following the instigation of executive-led overdue doses RCA meetings (reductions of 0.83 and 0.97 percentage points, respectively) and the publication of an associated NPSA Rapid Response Alert. Implementing a visual indicator for overdue doses was not associated with significant decreases in the rates of missed antibiotic or non-antibiotic doses. Conclusions Electronic prescribing systems can facilitate data collection relating to missed medication doses. Interventions providing hospital staff with information about overdue doses at a ward level can help promote reductions in overdue doses rates. [ABSTRACT FROM PUBLISHER]

Objectives Interventions to drive quality of care using strategies to empower clinical staff with personal and local performance indicators should lead to measurable improvements in outcome. The current evidence for the linkage of quality metrics and patient outcome usually relies on surrogate measures. There is a continuing need for the development of specific measurable indicators of quality of care, which have demonstrable links to patient outcome. Design A single centre naturalistic study to validate electronically collected drug administration and documentation measures of quality improvement, during the introduction of a quality improvement programme. Setting A large academic teaching hospital in the UK. Participants Staff involved in administration of prescribed medication using an in-house developed prescribing information and communication system (PICS). Main outcome measures Mortality data from nationally collected 'hospital episode statistics' and markers of the precision of medicines administration and documentation 'uncharted' and 'missed' drug doses. Results A 16.2% reduction in local mortality rate was demonstrated (P = 0.013) compared to static mortality rates throughout England. Similar temporal reductions were seen in the rates of missed and uncharted doses of medication at the hospital over the same period. Conclusions When monitored as part of a quality improvement strategy, 'missed' and 'uncharted' drug dose information may reflect wider institutional changes and act as a valid indicator of quality of healthcare more generally. [ABSTRACT FROM AUTHOR]