MEDICAL ERRORS: Nursing Errors Kill, Injure Thousands

Errors by "overwhelmed and inadequately trained" nurses accidentally kill and injure thousands of patients annually, while hospitals continue to cut staffing and slash budgets, a Chicago Tribune investigation found. Part one in a three-part series reported that, since 1995, registered nurses nationwide have accidentally killed more than 1,720 patients and injured 9,584 others. Although registered nurses serve as the "primary sentinels" of health care, a majority of hospitals have eliminated or replaced the role of their "best-trained, highest-paid" nurses, creating a "harried" work environment that often endangers patients. The Tribune examined three million state and federal records -- including FDA and HHS reports, federal and state hospital surveys and complaint investigations, court and private health care files and state nurse disciplinary records -- to uncover the "hidden role registered nurses play in medical errors." According to the findings, since 1995:

Registered nurses have killed at least 418 patients and injured 1,356 others by improperly operating infusion pumps, which regulate medicine flow;
Registered nurses have killed at least 216 patients and injured 429 others after failing to hear alarms built into lifesaving equipment, such as respirators and blood-oxygen monitors;
Unlicensed, unregulated nurse aides have killed at least 119 patients and injured 564 others;
Hospitals, previously staffed entirely by registered nurses, have relied "more heavily" on "lesser-trained and lower-paid" practical nurses and aides (Berens, 9/10).

The Tribune report on nursing follows last fall's broader Institute of Medicine study, which estimated that medical errors kill 44,000 to 98,000 hospital patients each year ( AP/Baltimore Sun, 9/10).

HMOs, Medicaid Cuts to Blame?
State and national disciplinary records show that registered nurses have caused more patient deaths and injuries annually than any other health care professional and the number of reported nursing errors in hospitals has increased in each of the last five years. According to the American Hospital Association, "inadequate" staffing and "insufficient" training resulting from the rise of managed care firms and the drop in federal Medicaid reimbursements have placed patients at greater risk. The Tribune found, however, that even "financially thriving" hospitals have cut nursing services to "preserve historic profit levels." In 1996, AHA President Dick Davidson warned hospital officials about the danger of nurse staffing "thinness" in a confidential report, noting, "Patients suffered, literally, because medications and vital, comforting services were delayed, confused or forgotten." In addition to problems with staffing shortages and shoddy training, lax disciplinary measures in most states do not severely punish nurses for mistakes and allow nurses who commit medical errors in one state to continue to practice in other states (Chicago Tribune, 9/10).

Infusion Pump Misuse
According to the second part of the Chicago Tribune report, easily preventable "free flow" errors associated with infusion pumps, which are typically operated by nurses to regulate medicine flow, have been linked to more than a hundred deaths over the last decade. Based on government records, registered nurses have killed at least 418 patients and injured 1,356 others by improperly operating the pumps. Most pumps are equipped with a mechanism called free-flow protection that prevents an overdose if nurses fail to manually engage a roller clamp that halts the flow of medicine; however, hospitals often opt for the older models, which are cheaper but also more "error-prone." One in four pumps used by hospitals today is capable of free flow, either because they lack safety mechanisms or because safety devices have been dismantled -- but because these models are not labeled, nurses have no way of knowing which kind of pump they are using. Experts contend that free-flow deaths could be easily prevented if nurses were properly trained in infusion pump safety and were less overworked (Berens, 9/11).

This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.