The Nebraska Center for Rural Health Research

The risk from medication errors…

Medication errors are the most common source of risk to hospitalized patients. On average, a hospitalized patient experiences one medication error a day. This lack of reliability in hospitals’ medication use practices results in 400,000 preventable medication-related injuries that cost $3.5 billion annually (Institute of Medicine, 2007). The vast majority of research regarding medication errors has been conducted in large tertiary care centers. Critical Access Hospitals (CAHs) are a category of limited-service hospitals created in 1997 as part of the Balanced Budget Act to maintain access to care in rural areas by providing cost-based reimbursement—CAHs are the nation’s smallest hospitals (Mueller, 2004). CAHs are limited to 25 inpatient beds for acute care and have an average inpatient length of stay of 96 hours. As of May 2007, there were 1,283 CAHs (Flex Monitoring Team Site, 2004),representing approximately one-fourth of the community hospitals in the nation (American Hospital Association, 2006).

In CAHs, limited resources, low patient volume, and lack of accreditation by the Joint Commission are associated with not fully implementing safe medication practices and with having limited on-site pharmacy support (Casey, 2006; Jones, 2006).  For example, our 2005 survey of a random sample of CAHs found that 20% were accredited by the Joint Commission, 52% had conducted a root cause analysis in the previous year, 79% dispensed the majority of oral medications in unit-dose form, 73% read back verbal orders, 76% obtained a pharmacist’s review of medication orders within 24-hours, and 43% had a pharmacist on-site fewer than 20 hours a week.12 Limited on-site presence of pharmacists in CAHs restricts pharmacists’ active participation in medication use and medication error reporting (Jones, 2004).