The Effects Of To Err Is Human In Nursing Practice

The Effects Of To Err Is Human In Nursing Practicethe 1999 Landmark

The 1999 landmark report titled “To Err Is Human: Building a Safer Health System” highlighted the unacceptably high incidence of medical errors in the United States and provided recommendations to improve patient safety. Since its publication, these recommendations have significantly influenced nursing practice in the U.S. healthcare system. A critical issue raised in the report is the lack of awareness among healthcare professionals regarding the frequency of errors occurring daily across all settings. Addressing this challenge requires implementing systemic changes, particularly through the advancement of health information technology (HIT) and nursing informatics.

Development and integration of information technology have played a vital role in transforming healthcare safety. Informatics tools such as Electronic Health Records (EHRs), Clinical Decision Support Systems (CDSS), barcode medication administration, and real-time error reporting systems have enhanced the accuracy, efficiency, and safety of patient care. For example, in many organizations, the transition from traditional paper charting to EHRs has improved documentation accuracy, reduced medication errors, and enabled quick access to critical patient information. These advancements directly respond to the concerns raised by “To Err Is Human” about the prevalence of errors and the need for a culture of safety.

In my current organization, one of the longstanding practices reflects the ‘current rule’ of manual documentation, which often leads to inconsistencies and delayed error detection. This traditional approach is still prevalent in some departments. Conversely, other units have effectively transitioned to the ‘new rule’ of using integrated EHR systems and automated alerts, which have significantly reduced adverse events. The use of alerts for allergies, drug interactions, and abnormal lab values exemplifies how technology facilitates proactive safety measures. Such transitions demonstrate the importance and impact of health IT in promoting safer patient outcomes, aligning with the report’s emphasis on system-based solutions.

Impact of Informatics on Healthcare Safety and Areas for Growth

Informatics has substantially contributed to enhancing healthcare safety by facilitating better communication, reducing human error, and improving clinical workflows. Electronic prescribing systems, for instance, have minimized medication errors by providing automated checks for allergies and drug interactions, directly combating the issues detailed in “To Err Is Human.” Additionally, real-time monitoring systems enable rapid detection of patient deterioration, allowing timely interventions. These technological applications foster a safety-oriented culture where errors are less likely to occur or are identified early.

Despite these advancements, there remain areas where growth is necessary. One such area is interoperability—the ability of different health IT systems to communicate seamlessly. Frequently, incompatible systems hinder comprehensive data sharing, undermining safety efforts. Furthermore, the usability of health IT interfaces influences clinician compliance; poorly designed systems can lead to alert fatigue or workarounds that bypass safety protocols. Another issue involves the integration of informatics into nursing workflows, ensuring nurses receive adequate training and support to maximize the benefits of technology.

Furthermore, the culture of safety advocated in “To Err Is Human” must be continually reinforced. Transparency in error reporting, non-punitive environments, and continuous education are essential to sustain progress in safety initiatives. Informatics can support these cultural shifts by providing data analytics that identify patterns of errors and areas for targeted improvement. This evidence-based approach aligns with the recommendations for design principles and systemic change outlined in the “Quality Chasm” series.

Conclusion

The development and adoption of health information technology have significantly addressed the concerns raised in “To Err Is Human,” especially in reducing errors and promoting safer care environments. Informatics tools have transformed traditional workflows, improved documentation accuracy, and enabled proactive safety measures. Nonetheless, ongoing challenges such as interoperability, user-centered design, and fostering safety culture require continuous attention. As healthcare evolves, leveraging informatics effectively remains crucial to achieving the vision of a safer, more reliable healthcare system articulated in the landmark report.

References

• American Nurses Association. (2015). Nursing informatics: Scope & standards of practice (2nd ed.). Silver Springs, MD: American Nurses Publishing.
• Cipriano, P. F., & Murphy, J. (2011). Nursing informatics. The future of nursing and health IT: The quality elixir. Nursing Economics, 29(5), 282-289.
• McGonigle, D., & Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
• Plawecki, L. H., & Amrhein, D. W. (2009). Clearing the err. Journal of Gerontological Nursing, 35(11), 26–29.
• Wakefield, M. K. (2008). The Quality Chasm series: Implications for nursing. In R. G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses (Vol. 1, pp. 47–66). U.S. Department of Health and Human Services.
• Institute of Medicine. (1999). To Err Is Human: Building a Safer Health System. Washington, D.C.: National Academies Press.
• Cipriano, P. F., & Murphy, J. (2011). Nursing informatics. Nursing Economics, 29(5), 282-289.
• Laureate Education, Inc. (2012). Introduction to nursing informatics. Baltimore, MD: Author.
• McGonigle, D., & Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
• Hughes, R. G. (Ed.). (2008). Patient safety and quality: An evidence-based handbook for nurses (Vol. 1). U.S. Department of Health and Human Services.