Many hospitals have checks and balances systems to prevent errors, but what happens when the systems don't work? In the United States, medical errors are now the fifth leading cause of death. In 2000, the Institute of Medicine released a study titled "To Err is Human," revealing approximately 98,000 annual deaths due to medical errors. Although this figure is assumed to be lower than the actual figure, each death carries an inherent cost to the health system. Currently, this figure is underestimated, but the resulting cost is estimated at between $17 billion and $29 billion per year. According to Grober and Bohnen (2005), “medical error can be defined as “an act of omission or commission in planning or execution that contributes to nurses providing a competent level of care that is indicative of their training, experience, skills, and ability to act in accordance with agency policies or procedures. In a study of 1,116 hospitals, Bond, Raehl, and Franke (2001) found that “medication errors occurred in 5.07% of patients admitted to these hospitals each year. Each hospital experienced a medication error every 22.7 hours (every 19.73 admissions). Medication errors that negatively impacted patient care outcomes occurred in 0.25% of all patients admitted to these hospitals/year” (p. 4). This means that at least one medication error occurs every 24 hours in the facilities studied, and these are preventable errors. The main responsibilities of nurses when administering medications are to prevent or detect errors and report them. Even if the prescribing doctor or healthcare professional made an error in the prescription, it is up to the nurse to question the prescription. As medical errors increase length of stay and cost of care, hospitals face even smaller margins. Struggling to generate profits, the only way hospitals can grow is by improving the quality of care and reducing errors. It was not until recent legislation that hospitals were reimbursed for poor quality care leading to longer stays or new nosocomial infections. The recent health care reform law, the Patient Protection and Accountable Care Act, prevented hospitals from receiving reimbursement for readmissions due to error or hospital-acquired infections. Not only does this law prevent reimbursement for poor quality care, but hospitals that provide lower quality care will not be able to participate in Medicare and Medicaid programs (Andel et al..,