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Patricia Smith, RN, is the patient care coordinator at Beebe Medical Center in Lewes, Delaware, knows first hand how the errors in the health care profession can mean the difference between life and death.

Patricia Smith, RN, patient care coordinator at Beebe Medical Center in Lewes, Del., remembers exactly when it hit her that the errors in the health care profession can mean the difference between life and death.

It was a hectic day decades ago, but Smith, a 34-year veteran, recalls it like it was yesterday. She was dispensing pain medication to a child when she had to step away briefly to address an urgent matter. She quickly returned to dispensing the medicine, but the interruption had caused to her lose sense of how much she had administered.

She caught herself in time to keep from giving her young patient an overdose.

"It really shocked me," Smith said. "Something like that can make a different nurse out of you. It makes you extra cautious and much more thorough in every step you take."

As Smith's recollection illustrates, the issue of patient safety is hardly a new one. What is different about it these days, many nurses and other health care professionals say, is the amount of attention it receives inside and outside the industry.

What helped to start it all was the highly publicized 1999 report "To Err is Human" by the Institute of Medicine. The work, which detailed how tens of thousands of patients die each year because of medical errors, opened the eyes of many Americans to the problem and prompted a collective gasp from the country. Recent headline-grabbing mistakes, from an amputation of the wrong limb to a transplant of an incorrectly matched heart, have fueled the public's consternation.

"Patients have become much more aware of this issue," Smith said. "They're asking more questions, examining more closely the pills they take and getting more involved overall."

All of this is a good thing, Smith and others say. The increased public scrutiny, they contend, has prompted greater action.

From the introduction of patient safety goals by the Joint Commission on Accreditation of Healthcare Organizations to renewed efforts by hospital staffs across the country, the medical community is seen by many to be moving more aggressively to combat mistakes and create a safer environment for patients-and reverse the accidental death figures that so shocked the nation several years ago.

Nearly every discussion with nurses and other health care professionals about patient safety begins with a similar refrain: The No.1 problem is the staffing shortage that has plagued the nursing field for years. The bottom line, health care providers say, is that too few nurses take on too many tasks and patients and work too many hours. All of which is a recipe for medical foul-ups.

"Good people are making mistakes because of the staffing problem," said Mary Foley, past president of the American Nurses Association. "Errors and fatigue are related."

Short of rebuilding the nursing population, however, hospitals around the country are taking various alternative steps to enhance patient safety. So, too, are medical organizations, including JCAHO.

In July 2002, commission officials issued six major patient safety goals and recommendations-the first ever by the organization. Accredited facilities were expected to implement the recommendations, which range from improving the accuracy of patient identification to enhancing the effectiveness of clinical alarm systems, by January.

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