American Journal of Nursing 2000 February Volume 100, Issue 2

The Rising Tide of Health Care Errors

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Health care errors cause between 44,000 and 98,000 deaths each year, according to a November 1999 report from the Institute of Medicine (IOM). The specter of punishment in response to health care errors can be intimidating. For example, three Colorado nurses were indicted on criminal charges in 1997 after an infant died due to a medication error. And a few months ago, 13 nurses involved in a 1994 fatal chemotherapy overdose at Boston’s Dana-Farber Institute were reprimanded by the Massachusetts Board of Registration in Nursing.

Understandably, nurses are reluctant to report health care errors. Yet the only way to lessen the number of health care mistakes is to document and analyze the problem and its contributing factors. The IOM report contains specific recommendations about creating an environment that encourages health care providers to report errors. These include:

• Establishing a national focus to create leadership, research, tools, and protocols to broaden knowledge about safety

• Identifying and learning from errors through mandatory reporting, and encouraging voluntary reporting

• Raising standards and expectations regarding safety

• Creating safety protocols within health care organizations

Findings in the IOM report and earlier studies have prompted a number of organizations—the ANA among them—to work together on strategies that protect patients and discourage organizations from going on the “search-and-destroy” missions that frequently follow serious health care mistakes. In addition to its own Safety and Quality Initiative, the ANA participated in the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry. It is also a founding member of the National Coordinating Council for Medication Error Prevention (which can be accessed at http://www.nccmerp.org), and is actively involved in the American Medical Association’s National Patient Safety Foundation (available at http://www.npsf.org) and the National Patient Safety Partnership of the Veterans Health Administration).

The most significant aspect of the IOM report from a nursing perspective is its assertion that most errors are the result of failures in the health care system rather than human recklessness—a position the ANA has long held. Specifically, a 1998 ANA House of Delegates action report, “Shared Accountability in Today’s Work Environment,” emphasized teaching policymakers and the public about the effects of downsizing, restructuring, and reorganizing on safety and quality of care; working with other health care organizations to identify and correct system errors that lead to patient injuries; supporting nurses as they correct system errors through quality improvement initiatives; protecting nurses by enacting whistleblower legislation; and educating regulators and accrediting bodies about the negative effects of categorizing health care errors as criminal acts.

Nurses can greatly enhance the success of system-wide actions to reduce errors if they actively participate in their state nurses associations, collective bargaining units or workplace advocacy committees, and communities. Working with these groups, they can educate, advocate, and negotiate for provisions that protect and improve the safety and quality of patient care. Nurses can also bring a unique perspective to the national dialogue by emphasizing the effect of inadequate and inappropriate staffing on the incidence of health care errors—an aspect not touched upon in the IOM study. An excellent resource for learning how to promote this dialogue is the ANA’s “Principles for Nurse Staffing” (visit http://www.nursingworld.org and click on “Reading Room”).

For more information on reducing health care errors: http://www.nursingworld.org/readroom/nti/9808nti.htm