Costs and Root Causes of Medication Errors and Falls in a Teaching Hospital: Cross-Sectional Study

Abstract

Objectives to characterize accidents/falls and medication errors in the care process in a teaching hospital and to determine their root causes and variable direct costs. Method cross-sectional study implemented in two stages: the first, was based on the analysis of secondary sources (notifications, medical records and cost reports) and the second, on the application of root-cause analysis for incidents with moderate/severe harm. The study was carried out in a teaching hospital in Paraná, which exclusively serves the Brazilian Unified Health System and composes the Network of Sentinel Hospitals. Thirty reports of accidents/falls and 37 reports of medication errors were investigated. Descriptive statistical analysis and the methodology proposed by The Joint Commission International were applied. Results among the accidents/falls, 33.3% occurred in the emergency room; 40.0% were related to the bed, in similar proportions in the morning and night periods; 51.4% of medication errors occurred in the hospitalization unit, the majority in the night time (32.4%), with an emphasis on dose omissions (27.0%) and dispensing errors (21.6%). Most incidents did not cause additional harm or cost. The average cost was R$ 158.55 for the management of falls. Additional costs for medication errors ranged from R$ 31.16 to R$ 21,534.61. The contributing factors and root causes of the incidents were mainly related to the team, the professional and the execution of care. Conclusion accidents/falls and medication errors presented a low frequency of harm to the patient, but impacted costs to the hospital. Regarding root causes, aspects of the health work process related to direct patient care were highlighted.

Determining Medication Errors in an Adult Intensive Care Unit

“…Namely, for each additional type 2 error (scheduling error), hospitalization costs would increase by BRL 121.92, while for type 7 error (prescription error), hospitalization costs would increase by BRL 63.51. Other studies have confirmed this finding, verifying an increase in the average hospitalization cost associated with ME [ 15 , 35 , 37 ]. Interestingly, when analyzing these authors’ results, an increase in hospitalization costs correlated with the use of the ICU service and an average hospital stay longer than seven days, probably because these two factors lead to an increase in the use of technologies, more complex care, and increased hospital expenses.…”

“…Karthikeyan et al [ 33 ] reported prescription error frequencies ranging from 7.1 to 68.2%, as did Mekonnen et al’s [ 34 ] study, in which the average of prescription errors was 57.4% with a range between 22.8% and 77.8%. On the other hand, Pimentel et al [ 20 ] found a 29.7% incidence of scheduling errors and a 76.4% incidence of prescription errors in their study, whereas Paulino et al [ 35 ] reported a 27% incidence of dose omission errors.…”

“…Against this background, it is imperative to study the ME-related costs for their impact on health institutions, patients and their families, and society as a whole, as their minimization directly affects the health economy by reducing these expenses that generate a potential benefit for interventions aiming to address these types of errors [ 15 , 17 , 24 , 25 , 35 ]. Accordingly, it is paramount to identify the factors that cause medication errors, their damage, and the costs passed on in this process.…”

Safety culture in healthcare: mixed method study

“…The results of the qualitative study phase further validated our quantitative findings. The literature confirms that there are organizational influences, created by management decisions, that have an impact on the safety of the entire care system and the provision of healthcare (Santiago and Turini, 2015;Paulino et al, 2021). In addition, the personal characteristics of healthcare professionals, patients and family members have been identified as factors in the variability of daily clinical practices (Salmond and Echevarria, 2017).…”

Falls Suffered by Hospitalized Adult Patients: Support to the Nursing Team as the Second Victim

“…Falls cause injuries in almost half of the patients who are affected by this event, which may, in the most severe cases, lead to death (2). In addition, a fall can generate psychological impact by the fear of the patient falling again, which influences the risk of future falls (5), in addition to negatively interfering with the patient's functional capacity and mobility (6), which can increase the length of hospital stay and care costs, generating anxiety in the nursing team and producing repercussions on the institution's credibility, in addition to legal consequences (7,8).…”