Risk Management in Healthcare: Falls, Medication Errors & Liability

Introduction

Medication errors and patient falls are among the top events that can cause harm to patients and, consequently, increase the costs of hospitalization. In a healthcare environment, a professional nurse can be held liable for damages if her conduct falls below the standard of care and causes injury to patients. This paper explores the concepts of patient falls, medication errors, and nursing liability, and recommends strategies nurses can use to promote a culture of safety within a healthcare environment.

Patient Falls in Healthcare Settings

A fall is an unintentional, sudden slip that leads to a change in position. Falls are one of the most common adverse events in hospital settings, with more than 37.3 million cases occurring globally each year. The World Health Organization (2012) reports that falls result in more than 424,000 deaths globally each year, and over 80% of these cases occur in developing countries. In the United States, fall rates range between 3.31 and 11.5 per 1,000 patients. However, Hitcho, Krauss, Birge, et al. (2004) note that the rate of falls is between 2.3 and 7 per 1,000 patients per day in the United States. Fall rates are highest among neuroscience patients, with rates recorded between 6.12 and 8.83 per 1,000 patients per day.

Nearly 30% of inpatient falls result in injuries, with between 4% and 6% resulting in serious injury. Fall-related injuries include subdural hematomas, fractures, excessive bleeding, and sometimes death. In the United States, fall-associated injuries increase healthcare costs significantly; patients who sustain injuries from falls incur approximately $4,200 more in healthcare costs than hospitalized patients who do not fall. Risk factors associated with falls include depression, increasing age, impaired cognition, visual impairment, and the use of certain medications such as sedatives, antipsychotics, and benzodiazepines.

Currie (2008) argues that fall prevention continues to be a considerable challenge for healthcare organizations because unintentional falls are common among people aged 65 and older. This age group falls at least once a year, and the event is more frequent among female patients than male patients. In the United States, fall-related injuries are the leading cause of accidental death among people over 65 years of age, resulting in 41 fall-related deaths per year out of every 1,000 people. Mortality and injury rates increase dramatically among people aged 85 and above. The consequences associated with falls are costly, and fall-related injuries account for more than 15% of re-hospitalizations after patients are discharged. In 2000, total estimated costs arising from falls were between $16 billion and $19 billion, with fall-related costs reaching $170 million. Injuries associated with falls range from 6% to 44% for acute inpatient falls, and serious injuries from falls range between 2% and 8%, resulting in approximately 90,000 serious injuries annually in the United States. Fall-related deaths are approximately 11,000 per year across the country.

A medication error is defined as an unintended failure in the drug prescription and treatment process that leads to harm to patients. More broadly, medication errors are a type of preventable event that could cause harm to patients or consumers through inappropriate medication use. Events that may lead to medication errors include poor order communication, flawed healthcare procedures, improper packaging, dispensing, administration, and distribution. Mistakes in drug dispensing, prescribing, preparation, storing, and administration can also lead to adverse events that create a public health burden.

Medication Errors and Their Impact

The British National Formulary (BNF) identifies the healthcare specializations with the highest rates of medication errors: analgesics (9.7%), antibacterial drugs (6.2%), bronchodilators (5.7%), and anti-anginal drugs (5.3%). McGreevey (2015) points out that a medication error occurs in one out of every two surgeries in the United States, leading to adverse harm to patients. The most common medication errors are incorrect dosage, labeling mistakes, and documentation errors. Hughes (2008) identifies poor communication as a leading factor contributing to medication errors, with negative effects on patient outcomes. In the United States, more than 1.3 million people sustain injuries from medication errors annually. The FDA notes that common causes of medication errors include improper drug dosing, and that the health consequences of such errors occur most frequently in people aged 60 and above, indicating that older patients face the greatest risks.

Cheragi et al. (2013) reveal that medication errors are widespread across healthcare environments, resulting in significant financial and human costs. For example, the error rate in anesthesia is approximately one error per five anesthetics administered. Other categories of medication error include lapses, slips, and deliberate violations. Similar to patient falls, Cheragi et al. (2013) argue that drug errors continue to incur additional high costs for both patients and healthcare organizations.

Conclusion

This paper examined key risk management events — medication errors, patient falls, and nursing liability — and demonstrated that these events can cause harm or serious injury to patients when appropriate preventive strategies are not in place. The paper suggests that nurses should continuously update their knowledge on the culture of safety to prevent medication errors within a healthcare environment, and that healthcare organizations must take an active role in building the systems, policies, and training programs necessary to support safe practice.