Szczepura et al have written an interesting and certainly important study on medication administration errors for older people in long-term residential care. My primary concern about this study is the term ¿disguised observation method¿ they use in the method section to describe their data collection. To support their data collection method, they specifically refer to a study by van den Bemt et al. (2009).
Within medication administration error research ¿disguised observation¿ is the observation of actual administration using independent observers as has been used in the study by van den Bemt et al. (2009) and in many other studies (e.g. Taxis et al. 2003). Observers are present and accompany staff during medication rounds recording all details of drug preparation and administration. Several methodological studies have confirmed this to be a valid and reliable method to establish the frequency of medication administration errors. It is therefore considered the ¿gold standard¿ method in this field (Allan Flynn et al. 2002; Dean and Barber 2001)
However, closely examining the method of data collection described by Szczepura shows that data on medication administrations were extracted from the central data base linked to the barcode medication administration system. This would suggest that an independent observer has not been present during medication rounds. Some types of error may not be possible to identify from electronic records, e.g. crushing of tablets with modified release, an error known to be relevant in long-term residential care.
The authors should clarify this point as well as discussing the possible limitations of not using observation of actual practice for their data.
Katja Taxis
Professor of Pharmacotherapy and Clinical Pharmacy
Department of Pharmacy
Section of Pharmacotherapy and Pharmaceutical Care
University of Groningen, The Netherlands
Reference List
Allan Flynn E, Barker KN, Pepper GA, Bates DW, Mikeal RL. Comparison of methods for detecting medication errors in 36 hospitals and skilled nursing facilities. Am J Health-Syst Pharm 2002; 59:436-446.
Dean B, Barber N. Validity and reliability of observational methods for studying medication administration errors. Am J Health-Syst Pharm 2001; 58:54-59.
van den Bemt PM, Idzinga JC, Robertz H, Kormelink DG, Pels N: Medication
administration errors in nursing homes using an automated medication
dispensing system. J Am Med Inform Assoc 2009, 16(4):486-492.
Taxis K, Barber N. Ethnographic study of incidence and severity of intravenous drug errors. BMJ 2003; 326:684-687.
concerns about study method
26 January 2012
Szczepura et al have written an interesting and certainly important study on medication administration errors for older people in long-term residential care. My primary concern about this study is the term ¿disguised observation method¿ they use in the method section to describe their data collection. To support their data collection method, they specifically refer to a study by van den Bemt et al. (2009).
Within medication administration error research ¿disguised observation¿ is the observation of actual administration using independent observers as has been used in the study by van den Bemt et al. (2009) and in many other studies (e.g. Taxis et al. 2003). Observers are present and accompany staff during medication rounds recording all details of drug preparation and administration. Several methodological studies have confirmed this to be a valid and reliable method to establish the frequency of medication administration errors. It is therefore considered the ¿gold standard¿ method in this field (Allan Flynn et al. 2002; Dean and Barber 2001)
However, closely examining the method of data collection described by Szczepura shows that data on medication administrations were extracted from the central data base linked to the barcode medication administration system. This would suggest that an independent observer has not been present during medication rounds. Some types of error may not be possible to identify from electronic records, e.g. crushing of tablets with modified release, an error known to be relevant in long-term residential care.
The authors should clarify this point as well as discussing the possible limitations of not using observation of actual practice for their data.
Katja Taxis
Professor of Pharmacotherapy and Clinical Pharmacy
Department of Pharmacy
Section of Pharmacotherapy and Pharmaceutical Care
University of Groningen, The Netherlands
Reference List
Allan Flynn E, Barker KN, Pepper GA, Bates DW, Mikeal RL. Comparison of methods for detecting medication errors in 36 hospitals and skilled nursing facilities. Am J Health-Syst Pharm 2002; 59:436-446.
Dean B, Barber N. Validity and reliability of observational methods for studying medication administration errors. Am J Health-Syst Pharm 2001; 58:54-59.
van den Bemt PM, Idzinga JC, Robertz H, Kormelink DG, Pels N: Medication
administration errors in nursing homes using an automated medication
dispensing system. J Am Med Inform Assoc 2009, 16(4):486-492.
Taxis K, Barber N. Ethnographic study of incidence and severity of intravenous drug errors. BMJ 2003; 326:684-687.
Competing interests
no conflict of interest