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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.

Quality improvement programme, focusing on error reduction: a single center naturalistic study