A number of recently reported medical errors has made headline news and has been sensationalized in the press, but medical errors have occurred throughout history.  The quiet “cover-up” to avoid embarrassment, reluctance to make negative statements about a colleague, the concern for potential loss of business in a facility if medical errors are made public, and the lack of knowledge of causation for the error have all contributed to a silent epidemic of increasing medical errors to unsuspecting healthcare recipients.

In the past, medical professionals were generally not blamed for errors. There was an aura of perfectionism associated with those administering healthcare. People do die in hospitals, so if a death occurred, it was regrettably sad but often not questioned by families. Blatant errors did result in legal filings, but many medical errors went undetected.  Frequently a healthcare professional had to have a reputation for significant and obvious repetition of injury to a patient before outside pressure occurred.  Frequently the healthcare professional that erred was subjected to reprisal, embarrassment, and the potential for legal maneuverings if the actual event was brought forth publicly.  This resulted in healthcare professionals not reporting many errors, even though they were aware of them.

Often, the healthcare professional might not be aware of his or her part in the actual error, such as in medication variances.  As an example, a pharmacist might misread a physician’s illegible medication prescription and the medication nurse might calculate the wrong dosage.  This scenario represents three medical errors from three different sources. The patient might have been so gravely ill that the actual cause of death was assumed to be from the disease process, instead of medical error.  The physician didn’t intend to write so that the medication would be misinterpreted.  The pharmacist thought he had interpreted the prescription correctly.  The nurse might not have realized she offered the incorrect dosage to the patient. Yet, in the end, a death occurred. A different outcome would have occurred if systems were in place to avoid this problem plagued scenario.

Modern day ease of information sharing and improved communications has sensationalized many of the reported stories of shocking errors. Examples of the wrong extremity amputated, newborns sent home to wrong parents, and medication errors of astronomical proportions causing deaths have the medical community, governing and accrediting bodies, and the general population concerned. Recent involvement of scientific communities in researching the extent of preventable errors has caused hospitals, healthcare professionals, accrediting bodies, national associations, educators, and patients to become alert to the extent of the problem.  Action for implementation strategies for medical error reduction and prevention is a dominant theme in healthcare today. 

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