COST OF MEDICATION-RELATED PROBLEMS AT A UNIVERSITY HOSPITAL

The cost to an institution of medication-related problems (MRPs) was s tudied. A retrospective chart review covering the period from July 199 2 through June 1994 was performed for patients at a university-affilia ted medical center hospital who were known to have had clinical conseq uences from an adverse drug reaction (ADR) or medication error. All in terventions resulting directly from the problem were recorded. A detai led list of patient charges was reviewed for each patient, and specifi c charges for the MRP-associated interventions were categorized as ext ra laboratory tests, noninvasive procedures, additional treatments, in vasive monitoring or procedures, increased length of stay, and intensi ve care. The cost of each intervention was calculated by applying the cost-to-charge ratio used in the institution's patient-charge-based ac counting system. A total of 109 patient charts were reviewed. A total of 349 clinical outcomes associated with MRPs, or an average of 3 outc omes per patient, were detected: The mean +/- S.E. cost of MRP-associa ted clinical outcomes to the institution ranged from $95 +/- 11 for ad ditional laboratory tests to $2640 +/- 596 for intensive care. The nex t most costly outcomes were increased length of stay and invasive moni toring or procedures. For the 1911 MRPs reported in 1944, the estimate d total cost was almost $1.5 million. A review of the medical records of patients for whom an ADR or medication error had been recorded show ed a high cost of these events to the institution, with the cost varyi ng with clinical outcome, and a correspondingly strong opportunity for pharmacists to intervene to save money and improve the quality of car e.