Non-compliance and errors of drug administration in patients discharged from acute medical wards

Abstract

Three hundred and fifteen patients discharged from acute general medical wards over an 18-month period were studied prospectively to determine deficiencies in medication ingestion from that expected by the hospital clinicians. Thirteen percent did not receive an entirely correct written prescription at the time of discharge from hospital. In 4.5 percent this was the sole reason for treatment failure. Excluding these patients, 40.5 percent of the remainder admitted to medication variations over a 1-6 week period. Non-compliance proved to be a cause of drug default by patients three times as frequently as simple error. Where all errors were considered the ratio was 2 : 1. Whereas non-compliance (indicating volitional intent) was a more common basis for medication variation in Europeans, simple error was a more common cause in Polynesians. Two out of every five of the latter group took incorrect or incomplete therapy because of misinterpretation of instructions, either provided by hospital clinical staff, or printed upon their medication containers. The reasons for non-compliance and simple error are elucidated and the problem of non-delivery of expected medication is discussed. In devising methods for improving accuracy of drug self-administration after discharge from hospital the entities of simple error and non-compliance warrant individual attention.