Medication Errors Create Costs in Spinal Surgery

Spinal surgeries have been on the rise due to changing demographics, high demands for the mobility by elderly patients, and improved surgical techniques.

The healthcare industry’s safety culture has focused on the impact of psychological factors and perioperative medications on quality and patient satisfaction. One report found that 49% of medication orders contained at least one error and that an error increased the risk of 3-month re-hospitalization by 520%. The study highlighted that medication errors were the most common source of adverse events in anesthetized patients.

Interestingly, surgeons were considered to be well positioned to collaborate with pharmacists to reduce these errors, as surgeons have unlimited access to the patient’s medical record and have considerable patient contact in elective cases. The European Spinal Journal published a study that investigated the nature of medication-errors in spinal surgery patients and medication reconciliation strategies.

The author retrospectively reviewed inpatient medication errors affecting spinal surgery patients in 2011 and 2013. A committee of hospital pharmacists, neurosurgeons and nurses assembled and implemented medication error remediation measures in 2012. Delays associated with failure to hold medications pre-operatively cost almost 10,000 Euros and delayed surgery by a mean of 11 days in the 2011 cohort.

The author identified 5 risk factors for medication errors:

· Holding medications preoperatively

· Issues associated with recording the medication history

· Errors prescribing postoperative analgesics

· Errors prescribing postoperative anticoagulants, and

· Errors within the medication list at discharge.

The team was decreasing errors by standardizing preparations, doses and the prescription process, and improving access to information via a web site and Smartphone application countered these risk factors.

Pharmacist intervention improved correct continuation of post-operative analgesics from 64% to 82% and post-operative anticoagulants from 38% to 80%. These interventions eliminated duplicated and incorrect orders for analgesics. The advent of pharmacy involvement increased correct anticoagulant dosing from 38% to 80%. The author found that staff reminders to complete discharge medication lists were wholly ineffective (similar to the findings of other studies).

Medication errors are an underappreciated cause of medication errors in spinal surgery patients. Having surgeons collaborate with hospital pharmacists and involving the patient in their own care can significantly curtail medication errors.