HHS Study Finds Extensive Nursing Facility Error and Patient Harm

Skilled nursing facilities are characterized by high levels of error and resulting patient harm, according to a recently published study by the U.S. Department of Health and Human Services (HHS).  The study revealed that one out of three patients in skilled nursing facilities experienced an error in medication, an infection, or some other kind of error related to their treatment and that 59% of these errors were preventable.

Moreover, 22% of errors resulted in lasting harm and 1.5% of patients who might otherwise have been expected to survive died as a result of mistakes or insufficient care.

Skilled nursing care, the focus of the study, is defined as treatment in nursing homes or other facilities that provide such care up to 35 days after discharge from a 3-or-more day stay in a hospital. Some 90% of skilled nursing care facilities are also nursing homes, where long-term care is provided.  The study considered records of 653 randomly selected Medicare patients from over 600 such facilities.  Though there has been much more focus on errors occurring in hospitals, data from the study shows that errors occur far more frequently in nursing homes, raising concerns for those who study nursing home abuse.

Extrapolating data from the study at a national level, 21,777 patients were harmed and 1,538 died due to medical error in skilled nursing facilities in a period of only one month (August of 2011).  Over half of the patients who were harmed due to error had to be readmitted to the hospital, accounting for 2% of all Medicare inpatient spending (or $208 million during that month).

Nursing home abuse: error and neglect

The study reports that injuries to patients that resulted from errors included blood clots, fluid imbalances, kidney failure, and excessive bleeding.  Errors involved such factors as failure to adequately monitor patients, failure to provide necessary treatment in a timely fashion, and, in some cases, failure to provide such treatment at all.  Such errors can fall under the rubric of nursing home abuse, in that gross neglect is one type of such abuse.

The executive director of the Long Term Care Community Coalition, Richard Mollot, noted that problems such as errors in medication and bedsores that appeared in the study are factors that nursing homes should be able to address.

Causes, accuracy of errors in nursing facility abuse study debated

Some, such as John Sheridan, of the American College of Health Care Administrators, have debated whether the findings in the study are broadly representative, as the sample examined in the study is on the small side, and have stated that it is not true that less is known about nursing home safety than hospitals.  Dr. Jonathan Evans, president of the American Medical Directors Association, describes how nursing home facilities were not designed to meet the more intensive needs of patients coming out of the hospital and have not adapted as quickly to the new responsibilities.

Dr. Marty Makary, a physician at Johns Hopkins Medicine, argued that rather than simply submitting to once-a-year inspections, hospitals need to develop ways to track patient care on a day-to-day basis.