Date of Award/Publication


Document Type


Degree Name

M.S. in Advanced Practice Nursing

First Supervisor

Christine Nelson-Tuttle


In October 2007, the Medicare system contemplated future introduction of a new policy, which would no longer pay for eight preventable medical errors. With this potential new change in policy it becomes increasingly more important for health care institutions to monitor (track) medical errors and determine what measures can be taken proactively to prevent the occurrence of errors. The errors that might not be financially reimbursed under Medicare in the future include: - Sponges and/or surgical tools left in patients after surgery - Treatment of problems arising from air embolisms or incompatible blood transfusions - Treatment of bedsores developed while in the hospital - Injuries caused by hospital falls - Infections arising from prolonged use of urinary and vascular catheters - Infection after coronary artery bypass surgery (Brooks, 2007) It is thought that other insurers will follow suit in cutting back reimbursement based on these same standards. Questions arise when considering theses changes: what is a medical error? Why is it important to track medical errors, and how can health care providers increase medical error reporting? The purpose of this project was the development of an educational program to educate healthcare workers on patient safety and the importance of how, when and why to report near miss errors.

Included in

Nursing Commons