Prevalence, nature and predictors of omitted medication doses in mental health hospitals: A multi-centre study

Richard N. Keers; Mark Hann; Ghadah H. Alshehri; Karen Bennett; Joan Miller; Lorraine Prescott; Petra Brown; Darren M. Ashcroft

doi:10.1371/journal.pone.0228868

Peer Review History

Original SubmissionAugust 21, 2019
15 Nov 2019 Decision Letter - Mojtaba Vaismoradi, Editor PONE-D-19-23592 Prevalence, nature and predictors of omitted medication doses in mental health hospitals: a multi-centre study PLOS ONE Dear Dr. Keers, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. We would appreciate receiving your revised manuscript by Dec 30 2019 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. 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Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out. We look forward to receiving your revised manuscript. Kind regards, Prof, Mojtaba Vaismoradi, PhD, MScN, BScN Academic Editor PLOS ONE Journal requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at http://www.journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and http://www.journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. In ethics statement in the manuscript and in the online submission form, please provide additional information about the patient records used in your retrospective study. Specifically, please ensure that you have discussed whether all data were fully anonymized before you accessed them and/or whether the IRB or ethics committee waived the requirement for informed consent. If patients provided informed written consent to have data from their medical records used in research, please include this information. Reviewers' comments: Reviewer #1: The paper is very well written and the subject is also considerable Please also consider the following: Please mention how 9 hospitals were selected? Did you get all the hospitals in the two centers? How did you calculate the sample size needed for this study? How was the sampling done? Were patients also satisfied with the use of medical information? Reviewer #2: The structure of the manuscript is well put together, however it has some defects that listed in below: Results - Line 179: “The rate of overall omissions including various subcategories is summarised in Table 1”. Why did you report total omitted doses including, ‘preventable’ omitted doses? If it is total, what about a column for ‘non-preventable’? - Please list out your exact findings related to predictors factors and then discuss about them. I cannot find them easily in the text, as a reader. Ethical approval - Further information is needed. For instance, any permission to access inpatient prescription charts? Discussion - Line 250: “We found evidence that particular patients may be experiencing more omitted doses”. What do you mean from "particular patients"? - Discussion more about implications of findings in clinical practice. [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0228868.r001
Revision 1
7 Jan 2020 Author Response RESPONSE TO REVIEWER COMMENTS PONE-D-19-23592 ‘Prevalence, nature and predictors of omitted medication doses in mental health hospitals: a multi-centre study’ Please see the attached file for the response to reviewer comments (formatted) Editorial Comments: 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at http://www.journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and http://www.journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Acknowledged. 2. In ethics statement in the manuscript and in the online submission form, please provide additional information about the patient records used in your retrospective study. Specifically, please ensure that you have discussed whether all data were fully anonymized before you accessed them and/or whether the IRB or ethics committee waived the requirement for informed consent. If patients provided informed written consent to have data from their medical records used in research, please include this information. Acknowledged – we have now made clear in the ethics statement that data were fully pseudonymised before being sent to the research team for analysis and that individual patient consent was not required by the research ethics committee for this service evaluation study. Reviewers' comments: Reviewer #1: The paper is very well written and the subject is also considerable Many thanks for these kind words and for reviewing our manuscript. Please also consider the following: Please mention how 9 hospitals were selected? Did you get all the hospitals in the two centers? A total of 11 hospitals were covered by the 2 participating NHS trusts, with 1 being excluded as this focused on long-stay forensic wards rather than acute ward environments and another due to reasons of local resource capacity. Specialist wards such as long-stay forensics, intensive care and child and adolescent care were excluded in order to help ensure study findings were generalizable. The manuscript (page 6) and our ‘Strengths and Limitations’ section in the Discussion (page 20) has now been updated to reflect this point. How did you calculate the sample size needed for this study? How was the sampling done? As this study was an exploratory service evaluation to measure medicines administration quality we did not perform a sample size ‘power’ calculation. The number of data collection days (n=6) was chosen based on local capacity as each NHS trust provided the data collectors (we also refer to NHS team capacity in our ‘Strengths and Limitations’ section in the Discussion), and the days were scheduled to ensure data were collected over a 3 month period to better reflect usual working practices. All patients on each ward were included if eligible following screening. The manuscript has now been updated with this information (see page 7). Were patients also satisfied with the use of medical information? As per yours and additional editorial comments, we have added a statement to our ‘Ethical Approval’ section which states that individual patient consent was not required by the research ethics committee for this service evaluation study. Reviewer #2: The structure of the manuscript is well put together, however it has some defects that listed in below: Results - Line 179: “The rate of overall omissions including various subcategories is summarised in Table 1”. Why did you report total omitted doses including, ‘preventable’ omitted doses? If it is total, what about a column for ‘non-preventable’? Many thanks for reviewing our manuscript and for providing these valuable comments. An important aim of our work was to present both the overall omitted dose rates, and the ‘preventable’ rates to the reader as findings concerning these ‘preventable’ omissions may help better focus local quality improvement efforts and future research in the field. However, we acknowledge that our focus on preventability of omissions could be clearer in our introduction and we have added text to achieve this (page 5) as well as in the discussion (page 17). We present the overall numbers of ‘preventable’ and ‘non-preventable’ omissions in Table 3 so the reader can compare their relative burden, and by comparing the numerator figures across columns 1 and 2 in Table 1, the reader can also determine the rates for ‘non-preventable’ omissions. This helps to focus attention on ‘overall’ and ‘preventable’ omissions whilst avoiding making Table 1 larger and more difficult to process for the reader. - Please list out your exact findings related to predictors factors and then discuss about them. I cannot find them easily in the text, as a reader. Within the results section page 14, we have a section entitled ‘Predictors of omitted doses’ where we describe all the statistically significant findings reported in Tables 4 and 5. We have now expanded on this section to include all findings (whether significant or not) from the analysis. Ethical approval - Further information is needed. For instance, any permission to access inpatient prescription charts? As per yours and additional editorial comments, we have added a statement to our ‘Ethical Approval’ section which states that individual patient consent was not required by the research ethics committee for this service evaluation study. Discussion - Line 250: “We found evidence that particular patients may be experiencing more omitted doses”. What do you mean from "particular patients"? Many thanks for this comment. We have removed reference to ‘particular patients’ and have added additional details concerning the predictors for ‘preventable’ omissions in this paragraph. - Discussion more about implications of findings in clinical practice. Based on your earlier helpful comments we have added some detail to the Discussion concerning the implications for preventable omissions. We have also now reviewed the Discussion and added lines of text across sections to help better link the findings to clinical practice, including ‘preventable’ omissions occurring at weekends and addressing patient refusals as a driving factor behind non-preventable omissions. Attachments Attachment Submitted filename: RESPONSE TO REVIEWERS_RKeers_PLOSONE_v1.docx https://doi.org/10.1371/journal.pone.0228868.r002
27 Jan 2020 Decision Letter - Mojtaba Vaismoradi, Editor Prevalence, nature and predictors of omitted medication doses in mental health hospitals: a multi-centre study PONE-D-19-23592R1 Dear Dr. Keers, We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements. Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication. Shortly after the formal acceptance letter is sent, an invoice for payment will follow. To ensure an efficient production and billing process, please log into Editorial Manager at https://www.editorialmanager.com/pone/, click the "Update My Information" link at the top of the page, and update your user information. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, you must inform our press team as soon as possible and no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. With kind regards, Prof, Mojtaba Vaismoradi, PhD, MScN, BScN Academic Editor PLOS ONE Reviewers' comments Reviewer #1: (No Response) Reviewer #2: Dear authors, Thank you for addressing all comments sufficiently. I therefore recommend to accept the manuscript for publication. ********** https://doi.org/10.1371/journal.pone.0228868.r003
Formally Accepted
29 Jan 2020 Acceptance Letter - Mojtaba Vaismoradi, Editor PONE-D-19-23592R1 Prevalence, nature and predictors of omitted medication doses in mental health hospitals: a multi-centre study Dear Dr. Keers: I am pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please notify them about your upcoming paper at this point, to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. For any other questions or concerns, please email plosone@plos.org. Thank you for submitting your work to PLOS ONE. With kind regards, PLOS ONE Editorial Office Staff on behalf of Professor Mojtaba Vaismoradi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0228868.r004

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