Several carers working shifts: how can you avoid medication errors?

When several people take turns caring for a relative, medication errors tend to start at the change of shift: these simple tools help prevent them.

To avoid errors when several carers take turns, you need three things: one medication list, a record where each person notes the doses they give and an orderly handover between shifts. With that, plus one person who coordinates changes, most mistakes can be prevented.

It is a very common situation: one carer in the morning, another in the afternoon, a son at the weekend. Everyone does their best, but if information does not flow, medication becomes a weak point.

Why is there more risk of error when several carers take turns?

Because every change of shift is a moment when information can get lost. If the person coming in does not know what has been given, they may repeat a dose or skip it, and if they are unaware of a recent change, they may carry on with the old regimen.

According to the Spanish Ministry of Health guide on the 5 key moments for the safe use of medicines (2022), errors caused by incorrect administration at home range from 19% to 59%, and cause harm in up to 26% of cases. Their main cause is a lack of information among the people who take or give the medicines. The Ministry also notes that, in primary care, around 59% of medication related adverse events could be avoided with safe practices. The WHO, for its part, considers transitions of care one of the three priority areas for reducing medication harm.

What information should every carer have to hand?

All carers should work from the same written, up to date medication list. The Ministry guide recommends that people who take medication, their relatives and their carers keep an up to date list of the medicines being taken and are informed of any change in treatment.

Keep the list in a fixed place, next to the medication, and a copy on the coordinator’s phone. When something changes, write a new dated list and remove the old one: two different lists at home are a sure source of errors.

Each carer should also know what they can and cannot do with medication. We explain this in our article on live in carers and medication.

How should doses be recorded so none are repeated or missed?

With a daily record sheet where each person ticks the dose straight after giving it, with the time and their initials. That way, whoever arrives for the next shift can see at a glance what has been given and what is still due.

• Tick the dose only after giving it, never before.
• If the person refuses or vomits a dose, write that down; do not repeat it without advice.
• If you do not know whether a dose was given, do not give it "just in case": call the pharmacy or the doctor.
• Keep all the medication in one place, separate from medicines that are no longer used.

If a double dose still happens, our article on what to do if a pill has been taken twice explains the steps.

How do you do a good handover between shifts?

A good handover takes a few minutes and always follows the same order. Ideally it is done in person or, if shifts do not overlap, in writing in a notebook or a messaging group used only for this.

1. Which doses have been given and which are due in the next shift.
2. Whether there has been any change in medication, who decided it and since when.
3. New symptoms: dizziness, drowsiness, falls, poor appetite, confusion.
4. Medicines that are running out and who is going to restock them.

Also, appoint a single person as coordinator: they talk to the doctor and the pharmacy, update the list and tell everyone about changes. The 5 key moments tool reminds us that the riskiest moments are starting a medicine, adding another, reviewing the medication and ending a treatment, exactly when it matters most that everyone is informed. If the person also moves between homes, read how to organise things when your father rotates between his children’s homes.

A practical example: Mercedes and her three carers

Let us take the case of Mercedes, aged 88, with mild cognitive decline and 7 medicines a day. Lucía looks after her in the mornings, Fátima in the afternoons and her son Jordi at weekends. One Monday, Lucía finds the Sunday night compartment of the pill organiser still full and does not know whether Jordi forgot or filled it twice.

To stop it happening again, the family decides:

1. Jordi will be the coordinator and the only one who talks to the doctor and the pharmacy.
2. To put up a single dated medication list in the kitchen and remove all the earlier ones.
3. To place a weekly record sheet next to it where each carer signs every dose.
4. To set up a messaging group just for handovers, with a short message at the end of each shift.
5. To ask the pharmacy to prepare the medication by day and time, so nobody has to fill pill organisers.

With the medication already prepared and a signed record, any carer knows in seconds what is due and what has been done.

How can IMA Health help you?

When several people give the medication, having it prepared in advance removes the step where people most often make mistakes: counting and sorting pills. At IMA Health we coordinate with a specialised pharmacy so the medication is prepared by day and time of each dose, we deliver it to the home and we provide personalised follow-up. Each sachet shows when it should be taken, so any carer can see what is due and check whether a dose has been given.

Sources

• Spanish Ministry of Health: 5 key moments for the safe use of medicines. Guide for healthcare professionals (March 2022, in Spanish)
• Spanish Ministry of Health: press release on promoting the safe use of medicines (September 2022, in Spanish)
• WHO: Medication Without Harm (Global Patient Safety Challenge)

This article is for information only and does not replace advice from your doctor or pharmacist.