A Cohort Retrospective Observational Study of Hospital Accreditation Influence on Medication Safety in Saudi Hospitals

BACKGROUND AND OBJECTIVES: Medication errors remain a leading cause of adverse events globally and in Saudi Arabia, accounting for up to 45% of reported medical errors. Despite accreditation programs aiming to improve patient safety, evidence of their impact on medication management (MM) standards is limited. This study addresses this gap by evaluating MM compliance in Saudi hospitals from 2016 to 2023, post-implementation of the Central Board for Accreditation of Healthcare Institutions' Essential Safety Requirements (ESR). METHODS: This retrospective cohort study analyzed ESR survey data from 454 hospitals nationwide. Of these, 161 hospitals met the inclusion criteria by completing all 6 annual ESR surveys (2016-2019, 2022-2023); 293 hospitals were excluded due to incomplete longitudinal data. Scores for 3 MM standards: MM5 (high-alert medication safety), MM6 (look-alike and sound-alike medication safety), and MM41 (medication error monitoring) were extracted. Statistical analysis included descriptive statistics, repeated measures analysis of variance, and independent t tests comparing 2016-2019 and 2022-2023 periods. MM compliance was not reported during the COVID pandemic period (2020-2021). RESULTS: Significant improvements were observed across all MM standards over time. Mean MM5 scores increased from 69.56 in 2016 to 95.66 in 2023, MM6 from 40.79 to 96.10, and MM41 from 61.13 to 93.27 (all P < .001). Independent t tests confirmed substantial gains: MM5 rose from 70.06 to 92.28 (t = -14.50, P < .001), MM6 from 71.59 to 95.63 (t = -15.41, P < .001), and MM41 from 64.98 to 88.17 (t = -14.63, P < .001). Ownership type showed no significant effect (P > .05), and hospital bed size had no meaningful impact on MM5 and MM6, with a minor trend for MM41 (P = .001 but not statistically significant). CONCLUSIONS: The period after implementation of the Central Board for Accreditation of Healthcare Institutions ESR standards saw significantly improved medication safety compliance in Saudi hospitals, suggesting the effectiveness of accreditation in promoting patient safety. Policymakers should sustain these efforts to maintain progress. Future research should evaluate patient outcomes, cost-effectiveness, and adopt mixed-methods approaches to explore contextual factors influencing compliance.