Medical Error
Medical Error: What is the Cost?
June 6, 2022
Joy Stepinski, MSN
Heart disease and cancer have consistently been named the first and second leading causes of death by the Centers for Disease Control and Prevention (CDC). Yet many are not aware that medical error is number three! The CDC publishes a list of top causes of death for the public, yet medical error is not listed among them. The mechanism of reporting a death is not a straightforward one. Because causes of death are assigned to an International Classification of Disease (ICD) code on the death certificate, human error is not captured. In this manner, the public is not aware that underlying causes of death may actually exist. To delve into this issue further, the medical literature must be scrutinized.
In 1999, a landmark report was published by the Institute of Medicine called “To Err as Human,” which shined the light on medical error. The report cited a study showing the number of people dying at the expense of hospital care was approximately 44,000 - 98,000 annually (Kohn et al., 2000). Although medication errors do not always result in death, the ramifications can be detrimental. The report indicated that 7,000 patients died from medication in 1993. One of 131 deaths resulted from outpatient medication error, and one out of 854 inpatient deaths. While these statistics may be outdated, the report lays the foundation on very important findings that brings awareness to this critical issue.
Makary and Daniel (2016) stress that the 1999 IOM conclusions on medical errors is underestimated. Their publication cites a study from 2013 that estimated 400,000 deaths result from medical error every year. In another study published by Oura (2021), the author reviewed patient death data from the year 2018. The research states “the present data indirectly supports previous evidence that a large number of adverse events remain underrecognized or misclassified.” Of 2,846,305 certified deaths investigated, approximately 0.16 to 1.13% were related to medical error.
What is the meaning behind the term medical error? The IOM defines medical error as either an error of execution, a planned action that is not completed as intended, or an error in planning, a failure of a plan to achieve its goal (Kohn et al., 2000). Often discussed along with medical error, an adverse event is an injury caused by medical mismanagement and not the underlying condition of the patient. This type of injury can occur as an error or as negligence, which is a failure to meet a standard of care provided to every patient. According to Gluyas and Morrison (2014), “studies identify that one in ten patients will experience an adverse event as the result of an error” (p. 39), half of those patients will have a serious injury and approximately one in thirty patients will experience an error that results in death.
Medication harm is among the most common type of medical error and likely the most preventable. These errors contain a price tag of $17 to $30 billion annually (Sahay et al., 2015). As stated by Islam et al. (2019), implications of medication error are extended hospitalization, increased cost, damage and injury to the patient, side effects, and death. The medication administration process can be complex due to a series of steps that occur. First, the healthcare provider must order the medication. Next, the pharmacist reviews the order and may need to prepare the medication, which may involve multiple steps. Finally, the nurse administers the drug. Reasons for errors may be miscommunication, miscalculation, and drug interactions. The nurse is the last line of defense before the medication reaches the patient.
Nurses consistently have led the list of professions in honesty and ethics for the 20th year in a row in 2021, according to the Gallup poll (Saad, 2022). The ANA Nursing Code of Ethics stresses the importance that nurses must maintain nonmaleficence by minimizing risk and mitigating harm to their patients. Yet the opportunity for medication harm by the nurse persists. In a recent highly publicized case, a Tennessee nurse suffered the revoking of her nursing license and charged criminally when a patient died after she administered a drug named vecuronium instead of versed (ISMP, 2021). Nurses are vulnerable to errors due to daily tasks, of which 50% of time is related to administering medications (Sahay, 2015), and also system failures (ISMP, 2021). Nurses may lack academic preparation, have immature critical thinking, face inadequate decision-making skills, possess poor time management, and experience inability to understand orders (Gluyas & Morrison, 2014).
Why is understanding medical error so important? The literature states that patients poorly comprehend problems related to medication administration and adverse events (Islam et al., 2019). Reasons may be related to assumptions about hospital care, trust in healthcare professionals, and lack of knowledge. The patient has the right to be informed of potential risks of harm. As expressed by Brach (2019), “it is a medical error when patients have procedures that they would not have chosen if they had fully understood all of the relevant information” (p. 5). By increasing one’s knowledge of medical error and informed consent, the patient can be equipped with information when visiting a hospital and receiving care. Additionally, medical error can be lessened by minimalizing hospitalizations with lifestyle changes, including nutrition and exercise.
References
Brach, C. (2019). Making informed consent an informed choice. Health Affairs. https://www.healthaffairs.org/do/10.1377/forefront.20190403.965852
Gluyas, H., & Morrison, P. (2014). Human factors and medication errors: A case study. Nursing Standard, 29(15), 37-42. https://doi.org/10.7748/ns.29.15.37.e9520
Institute of Safe Medication Practices. (2021). TN Board of Nursing’s unjust decision to revoke nurse’s license: Travesty on top of travesty! https://www.ismp.org/resources/tn-board-nursings-unjust-decision-revoke-nurses-license-travesty-top-tragedy
Islam, T., Latif, A., Nesa, M., Mallik, D. R. (2019). Medication management by clinical nurses at tertiary level hospital in Bangladesh. East African Scholars Multidisciplinary Bulletin, 2(6), 173 – 183. https://doi.10.36349/easmb.2019.v02i06.008
Kohn LT, Corrigan JM, Donaldson MS, (Eds.). Institute of Medicine (US) Committee on Quality of Health Care in America. (2000). To Err is Human: Building a Safer Health System. Washington (DC): National Academies Press (US).
Latif, M. A., Nesa, M., & Mallick, D. R. (2019). Medication Management by Clinical Nurses at Tertiary Level Hospital in Bangladesh. https://doi:10.36349/easmb.2019.v02i06.008
Makary, M. A., & Daniel, M. (2016). Medical error—the third leading cause of death in the US. British Medical Journal, 353. https://doi:10.1136/bmj.i2139
Oura, P. (2021). Medical adverse events in the US 2018 mortality data. Preventive Medicine Reports, 24, 101574. https://doi.org/10.1016/j.pmedr.2021.101574
Saad, L. (2022). Military brass, judges among professions at new image lows. GALLUP. https://news.gallup.com/poll/388649/military-brass-judges-among-professions-new-image-lows.aspx
Sahay, A., Hutchinson, M., & East, L. (2015). Exploring the influence of workplace supports and relationships on safe medication practice: A pilot study of Australian graduate nurses. Nurse Education Today, 35(5), e21-e26. doi:10.1016/j.nedt.2015.01.012