“To Err is Human: Building a Safer Health Care System,” was published in 1999 by the U.S. Institute of Medicine (IOM) and brought attention to the need for the reduction of medical errors in the US health-care system.
As a result of this publication, efforts were made at both the macro and micro levels of health care to improve patient safety. Hospitals implemented policies for improved medication administration. Surgeons were encouraged to adhere to “time out” procedures prior to initiating surgical interventions, during which they state the name of the patient and the duties of each clinician present. State licensing boards require continuing education be completed on the prevention of medical errors prior to licensure and again on renewal.
A medical error is defined by the IOM as “the failure to complete a planned action as intended or the use of a wrong plan to achieve an aim.” Awareness of the responsibility to prevent medical errors and improve patient safety is widely discussed and is addressed in the curriculum for registered nurses. Registered nurses are usually encouraged to be the patient’s advocates through this role, and much of the time they are the last line of protection against an error. This background often makes nurse practitioners better at completing the planned action as intended and using the correct plan to accomplish an aim.
It can be perceived that errors in the acute care setting are of a greater magnitude due to the greater complexity of the patient and the higher intricacy of procedures and treatments. Although the acute care setting by nature creates a more likely place for medical errors to occur, outpatient settings are not exempt from the need to reduce medical errors. While it is unlikely that a primary-care provider will amputate the incorrect limb, it is quite possible that they could order imaging of the incorrect limb. Both of these actions would be considered errors and would affect that patient and their health outcome negatively.
A challenge in the use of the electronic health records (EHRs) and the ability to simply click on a medication and electronically prescribe, as opposed to the use of a script pad and handwritten prescription, is the increased likelihood of incorrectly prescribing medication. EHRs do not require that you take the time to specifically write out the details of what the patient needs, which can lead to errors. However, many EHRs have a “favorites” feature that allows commonly prescribed medications to be stored in a database and chosen when appropriate. I frequently utilize my medical assistant to ensure that correct imaging is ordered and medications are sent to the correct pharmacies. The medical assistants in my practice are expected to review their clinical summary with the patient. This dialogue allows for adequate communication between the patients and is necessary to ensure outcomes are met.
When errors do occur, it is often necessary to evaluate the system in which the error occurred to ensure that all individuals are included in changing behaviors to prevent errors in the future. While to err is human, to ensure that high quality healthcare is delivered to individuals at defenseless human moments is vital to the practice of medicine.
Leigh Montejo, MSN, FNP-BC, is a National Public Health Service Corp scholar completing her service commitment as a Family Nurse Practitioner at Tampa Family Health Centers Inc. in Florida. Her areas of interest include adolescent health, health promotion and improving access to healthcare in underserved populations.