Clinical Pharmacy Services, Hospital Pharmacy Staffing, and Medication Errors in the United States Hospitals C. A. Bond, Pharm.D., FASHP, FCCP, Cynthia L. Raehl, Pharm.D., FASHP, FCCP, Todd Franke, Ph.D. Abstract and Introduction Abstract The direct relationships and associations among clinical pharmacy services, pharmacist staffing, and medication errors in United States hospitals were evaluated. A database was constructed from the 1992 National Clinical Pharmacy Services database. Both simple and multiple regression analyses were employed to determine relationships and associations. A total of 429,827 medication errors were evaluated from 1081 hospitals (study population). Medication errors occurred in 5.22% of patients admitted to these hospitals each year. Hospitals experienced a medication error every 22.04 hours (every 19.13 admissions). These findings suggest that at minimum, 90,895 patients annually were harmed by medication errors in our nation's general medical-surgical hospitals. Factors associated with increased medication errors/occupied bed/year were drug-use evaluation (slope = 0.0023476, p=0.006), increased staffing of hospital pharmacy administrators/occupied bed (slope = 29.1972932, p<0.001), and increased staffing of dispensing pharmacists/occupied bed (slope = 19.3784148, p<0.001). Factors associated with decreased medication errors/occupied bed/year were presence of a drug information service (slope = -0.1279301, p<0.001), pharmacist-provided adverse drug reaction management (slope = -0.3409332, p<0.001), pharmacist-provided drug protocol management (slope = -0.3981472, p=0.013), pharmacist participation on medical rounds (slope = -0.6974303, p<0.001), pharmacist-provided admission histories (slope = -1.6021493, p<0.001), and increased staffing of clinical pharmacists/occupied bed (slope = -9.5483813, p<0.001). As staffing increased for clinical pharmacists/occupied bed from the 10th percentile to the 90th percentile, medication errors decreased from 700.98 ± 601.42 to 245.09 ± 197.38/hospital/year, a decrease of 286%. Specific increases or decreases in yearly medication errors associated with these clinical pharmacy services in the 1081 study hospitals were drug-use evaluation (21,372 more medication errors), drug information services (26,738 fewer medication errors), adverse drug reaction management (44,803 fewer medication errors), drug protocol management (90,019 fewer medication errors), medical round participation (42,859 fewer medication errors), and medication admission histories (17,638 fewer medication errors). Overall, clinical pharmacy services and hospital pharmacy staffing variables were associated with medication error rates. The results of this study should help hospitals reduce the number of medication errors that occur each year. Introduction A 1999 report from the Institute of Medicine suggested that medical errors account for 44,000-98,000 deaths/year.[1-3] These deaths exceed the eighth leading cause of death in the United States.[4] The estimated total cost of the medical errors is $17-29 billion annually.[5,6] Medication errors are the largest component of medical errors.[1,3] Whereas the frequency of medication errors has been documented, there has been little study of the factors associated with the root causes of these errors.[7] Substantial evidence suggests that pharmacists in decentral-ized patient-care settings can substantially reduce the frequency of medication errors,[8-10] yet virtually nothing is known about which specific pharmacy services or pharmacist functions produce these reductions in medication errors. Medication errors occur in 3-6.9% of hospital inpatients.[2,3,11-14] The error rate for inpatient medication orders varies from 0.03-16.9%.[11,15-17] In perhaps the best controlled study of medication errors in hospitals, researchers determined that 11% of medication errors in hospitals are pharmacy-dispensing errors in which the wrong drug or incorrect strength is prescribed.[9] A 1999 report on hospital medication errors (hospital self-reported) compiled by the United States Pharmacopeia found that only 17% of 6224 medication errors were due to dispensing errors.[18] Despite these findings, much of organized pharmacy's efforts to decrease medication errors have focused on the ordering and dispensing system, rather than the patient-care system, where the bulk of medication errors occur. Unfortunately, nearly all medication error studies to date have been conducted in a small number of sites (hospital or pharmacy) or with a limited number of patients. Little is known about which factors or pharmacy services might be associated with increased or decreased medication errors in a large population of hospitals. More studies assessing the risk of medication errors are needed to determine the best methods to reduce medication errors. We employed a population-based approach to assess pharmacy factors associated with medication errors in our nation's hospitals. This study evaluated the direct relationships and associations among clinical pharmacy services, pharmacist staffing, and medication errors in U.S. hospitals. This is the first study to evaluate the impact of clinical pharmacy services and pharmacy staffing on medication errors in a large number of hospitals. C. A. Bond, Pharm.D., FASHP, FCCP, Cynthia L. Raehl, Pharm.D., FASHP, FCCP, Todd Franke, Ph.D.; Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center-Amarillo, Amarillo, Texas; School of Public Policy and Social Research, University of California at Los Angeles, Los Angeles, California. Pharmacotherapy 22(2):134-147, 2002. © 2002 Pharmacotherapy Publications Healthcare Without Harm, Thanks to PANUPS, 12/03 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.