Reducing Medication Errors and Increasing Patient Safety: Utilizing the Fault Tree Analysis

摘要

According to the 2000 Institute of Medicine Report on Building a Safer Health System, experts estimated that 8000 Americans die every year from preventable medication errors. It is believed that these errors annually affect more than 7 million patients with the cost of approximately $21 billion across all care settings. Despite some developed studies on analyzing the contributing causes of medication errors, there is a need for the development of more robust, systematic methodologies to identify their root causes and provide preventive measures to avoid their recurrence. This paper proposes a methodology, which is an integration of Failure Modes and Effects Analysis(FMEA)and Fault Tree Analysis(FTA), to first identify one of the top most important categories of medication error and then analyze its contributing and root causes. In this study, we develop FTA for administration errors, as they are highly occurring and very severe among other medication error categories.