Generic substitution of drugs in hospitals

Nurses are frequently required to undertake generic substitution of drugs in hospitals. According to the prevailing regulations, nurses may only undertake such substitution based on the Norwegian Medicines Agency's substitution list or the local substitution list in the hospital's quality system. A total of 600 nurses in 23 surgical and 28 medical wards in three health trusts were invited to participate in an online questionnaire survey on the generic substitution of drugs in hospitals. The study was undertaken to assess how current practice functions with regard to risk factors, documentation and potential improvements. The response rate for the survey was 52 %. A total of 57 % of nurses undertook generic substitution of drugs on a daily basis, while 8 % equally often left the decision to the doctor. In six hypothetical examples of generic substitution, the median number of incorrect responses by the nurses was two; the local substitution list was used as the only source of information in 23 % of cases, and none of the nurses used the Norwegian Medicines Agency's online substitution list. Altogether 37 % responded that generic substitution was recorded in 80 % or more of cases, while 18 % responded that a double-check was performed in 80 % or more of cases. Generic substitution in hospitals entails a significant possibility of errors. Safety and documentation of generic substitution should primarily be taken care of by computerised solutions, with the introduction of an electronic medication chart. Alternatively, the approved substitution list should be the only source used for substitution.