Medical Errors and Errors in Healthcare Delivery

Defining Medical Error

There is much debate in the medical literature surrounding the definitions of error, adverse events, mistakes, and near misses. However, the most commonly used definition of error is from the seminal report by the Institute of Medicine (IOM), To Err Is Human: Building a Safer Health System. As an exploration of medical error, error was defined in this publication as occurring when persons fail to complete an action as planned or intended (an act of omission), or they use an incorrect plan to achieve an aim (an act of commission). In doing something wrong or not doing something right, an undesirable outcome may or may not result.

If the resultant injury is caused by the medical care received by the patient rather than the patient's underlying illness, it is considered a preventable adverse event. It can result from a single error or an accumulation of errors. If the error results in serious harm or death to the patient, it is referred to as a sentinel event. Sentinel events usually require further investigation and may often reveal significant deficits in policies or current practice.

Some adverse events may be defined in legal terms as negligent adverse events. In these cases, a legal ruling is made as to whether an injury resulted because the care did not meet a standard of care reasonably expected to be delivered by an average clinician.

Sometimes an error does not result in a patient injury; it is then considered a near miss or close call. Near misses are potentially harmful incidents or errors that do not cause harm to patients either [Page 747]because effective recovery action was taken or because no harm resulted from the error. For example, a nurse identifies an incorrect drug prescription prior to drug administration.

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