Hospitals in the United States are aware that in order to improve patient outcomes and avoid errors, quality and operation efficiency need to be improved. Preventable errors were responsible for almost $20 billion in additional costs to hospitals in 2008 (Andel et al., 2012). Increased instances of hospital-associated infections such as MRSA continue to rise. In order to lower costs, hospitals need to implement quality improvement programs that will improve care, reduce the incidence of infections, and reduce their liability costs.
According to Andel et al. (2012), a recent studied identified the number one problem facing hospitals is medication safety. While it has not been proven, it is suspected that the recession has had an impact on patient safety. Where medications are concerned, there has been a reduction in personnel such as medication safety officers, and those who remain spend much less time reviewing medication. A reduction to nursing staff and more part-time nurses further complicates the problem, as they may not be knowledgeable in procedures regarding medication procedures. Purchases of medicines in multi-doses versus single dose vials may save money initially for hospitals, but they raise the risk that costly mistakes may be made by at least five times the normal rate (Andel et al., 2012).
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Reducing Prescription Errors
Studies have identified how to reduce the amount of medication errors that occur in hospitals that address the main causes of prescribing errors and staffing issues with nurses. One study published in the Journal of Clinical Nursing (Shawahna et al., 2011) examined the frequency of errors related to prescribed medications before and after installing an electronic prescription system. Both inpatient and discharge records were studied for errors before and after the installation of the new system. For inpatients, the medication errors using written paper-based prescribing the error rate was 22.6 percent. With the introduction of the electronic system, the error rate was reduced down to 8.2 percent. When discharge records were analyzed for errors, it was found that under the old written method there was an error rate of 16.9 percent. With the electronic prescription system, the error rate was reduced down to 4.4 percent.
This shows a significant difference in how an electronic prescription system can reduce the amount of mistakes that are made that will have a negative outcome on patient care and result in higher costs for hospitals. Mistakes are more likely to happen with personnel being rushed, not knowing enough about particular medications or prescribing rules, and overall errors that are related to the patient in general (Shawahna et al.). Errors that occur because of misinterpretation of written prescription were greatly reduced using the electronic system.
Another way in which medication errors can be reduced is through having proper staffing of nurses. In a study that was published in Nursing Economics (Frith et al., 2012) a correlation was found that differences in nurse staffing have an impact on the number of medication errors. This is of concern to hospitals because quality outcomes will be tied to payment with the new healthcare laws. Nurses are seen as the failsafe between the patient and the error as it is often the nurse who catches the medication error before it reaches the patient.
The study found that the level of nursing experience has an effect on reducing medication errors. One strategy that has been found to reduce errors is change the ratio of RNs and LPNs that are scheduled. It has been determined that having more RNs on duty will work toward reducing errors related to prescribing medications. This of course mean higher costs to hospitals in means of payroll, but it reduces the costs that would be incurred if errors were made and caused a negative outcome with a patient’s care. Studies have shown the link between a higher ratio of RNs on staff to the increase in the quality of patient care. The concerns regarding providing quality health care and receiving reimbursement from the government is another factor to consider with the tradeoff of costs.
Reducing Infection Rates
Another costly problem that is facing hospitals is the high numbers of patients who contract hospital-acquired infections (HIA) during their hospitalizations. The exact cost to the hospitals has not been fully determined, but according to a 2000 CDC report, they are estimated to run in the range of $5 billion to $29 billion (Hassan et al., 2010). Even though fewer patients have been admitted to hospitals and have shorter stays, the incidences of HAI have increased from 7.2 for each 1000 days to 9.8. One theory for this occurrence is that today’s admitted patients are older and susceptible to infection because they are sicker than those in previous years are.
Focus needs to be placed on reducing infection risks because of the increased costs to hospitals, patients, and the Medicare system. In the UK, guidelines have been developed to help control the transmission of MRSA in hospitals and nursing homes (Gould, 2011), as this is one of the leading infections that are included under HIAs. Increased awareness of infection prevention needs to be established within these facilities along with screening of patients for these infections.
Conclusion
With the implementation of new healthcare reform laws, it is more important than ever to improve the quality of care within the hospital setting. This includes reducing medication errors and HIAs that add to the costs of healthcare and increase the hospital’s liabilities. By preventing many of these instances, the quality of patient care can be improved while reducing the massive costs that are borne by hospitals each year. Hospitals, however, must recognize the tradeoffs that must be made such as increased costs with rebalancing nursing staff and training that will benefit in reduced overall costs in the long run.
- Andel, Charles et al. (2012). The economics of health care quality and medical errors. Journal of Health Care Finance. 39(1): 39-50.
- Frith, Karen et al. (2012). Nurse staffing is an important strategy to prevent medication errors in community hospitals. Nursing Economics. 30(5): 288-294.
- Gould, Dinah. (2011). MRSA: Implications for hospitals and nursing homes. Nursing Standard 25(18): 47-56
- Hassan, Mahmud et al. (2010). Cost of hospital-acquired infection. Hospital Topics. 88(3): 82-89.
- Shawahna, Ramzi et al. (2011). Quality and safety: Electronic prescribing reduces prescribing error in public hospitals. Journal of Clinical Nursing. 20: 3233-3245
