Attitudes and perceived barriers influencing incident reporting by nurses and their correlation with reported incidents: A systematic review

Healthcare Professionals' Culture Toward Reporting Errors in the Oncology Setting

INTRODUCTION

 Reporting an error during a hospital journey is crucial to reduce such errors' recurrence and to learn from events. Therefore, this study aimed to investigate oncology staff's attitudes, perceived barriers, and strategy towards reporting incidents and errors.

METHODS

 A cross-sectional online survey was conducted among health professionals providing care to cancer patients in a tertiary healthcare hospital in Saudi Arabia in 2019. Data were collected using an online self-administered questionnaire distributed to the targeted population.

RESULTS

 A total of 211 participated in this study. Sixty-five percent of responders reported that they felt a need to reveal errors. The leading perceived barrier to reporting the events was that the staff wanted to avoid getting into trouble (60%), followed by worries about legal action (59.2%). The top-ranking strategy to improve reporting by nurses was to have clear guidelines to report errors, education and feedback by doctors, and further education and training by allied healthcare.

CONCLUSION

 The study revealed that healthcare professionals do possess a favorable attitude toward reporting errors. However, a major gap is still a barrier between attitude and practice, and this need creating a safe atmosphere where every healthcare professional feels safe and comfortable with reporting incidents is required to build a non-punitive environment to enhance the safety culture. On the other hand, the respondents listed different strategies to enhance reporting events and errors.

Interventions to Increase Patient Safety in Long-Term Care Facilities-Umbrella Review

INTRODUCTION

Patient safety in long-term care is becoming an increasingly popular subject in the scientific literature. Organizational problems such as shortages of medical staff, insufficient numbers of facilities or underfunding increase the risk of adverse events, and aging populations in many countries suggests that these problems will become more and more serious with each passing year. The objective of the study is to identify interventions that can contribute to increasing patient safety in long-term care facilities.

METHOD

A systematic review of secondary studies was conducted in accordance with the Cochrane Collaboration guidelines. Searches were conducted in Medline (via PubMed), Embase (via OVID) and Cochrane Library. The quality of the included studies was assessed using AMSTAR2.

RESULTS

Ultimately, 10 studies were included in the analysis. They concerned three main areas: promoting safety culture, reducing the level of occupational stress and burnout, and increasing the safety of medication use. Promising methods that have an impact on increasing patient safety include: preventing occupational burnout of medical staff, e.g., by using mindfulness-based interventions; preventing incidents resulting from improper administration of medications, e.g., by using structured methods of patient transfer; and the use of information technology that is more effective than the classic (paper) method or preventing nosocomial infections, e.g., through programs to improve the quality of care in institutions and the implementation of an effective infection control system.

CONCLUSIONS

Taking into account the scientific evidence found and the guidelines of institutions dealing with patient safety, it is necessary for each long-term care facility to individually implement interventions aimed at continuous improvement of the quality of care and patient safety culture at the level of medical staff and management staff.

Nurses competence in the reporting of medication-related incidents: An intervention study

Objectives

Less than 5% of all harmful medicine‐related incidents (MIs) or adverse drug reactions received by the Spanish Pharmacovigilance system are notified by Registered Nurses (RNs). The main objective of this study was to determine the impact of a multifaceted institutional intervention (MII) in patient safety on the reporting competence of medication incidents of hospital RNs.

Design

One‐group pre‐test–posttest design.

Setting

Tertiary, public, teaching hospital in Spain.

Participants

A total of 139 RNs responded to pre‐ and postintervention questionnaires constituting the paired sample subjected to analysis.

Intervention

A MII, consisting of educational activities and materials, change in MI reporting form from paper to electronic and appointment of reporting support services, was designed and directed to all hospital RNs and midwifes.

Main outcome measures

Overall MIs reporting competence (OC) and its dimensions (attitudes, knowledge and skills) were measured through a synthetic variable (total OC value range: 34–170 points) by means of an electronic questionnaire.

Results

A statistically significant 7.96‐point increase in OC from baseline to the final measurement was obtained (CI: 5.05–10.85). There was an increase of 7.38 points in the skills dimension (CI: 5.06–9.68). After the MII, 73.4% nurses improved their OC and 33.8% reported at least one no‐harm MI postintervention compared to 4.4% pre‐intervention (p < .001). A one‐point increase in OC improved the probability of becoming reporter by 2.9% and a one‐point increase in skills by 6.4%.

Conclusion

MIs reporting competence among RNs increased after a multifaceted institutional intervention, due to an improvement in the skills dimension. The MII was also effective in raising both, the rate of RNs who become reporters and the number of no‐harm MIs reported.

Barriers to Incident Reporting among Nurses: A Qualitative Systematic Review

Incident reporting in health care prevents error recurrence, ultimately improving patient safety. A qualitative systematic review was conducted, aiming to identify barriers to incident reporting among nurses. Joanna Briggs Institute methodology for qualitative systematic reviews was followed, with data extracted using JBI QARI tools, and selected studies assessed for methodological quality using Critical Appraisal Skills Program (CASP). A meta-aggregation synthesis was carried out, and confidence in findings was assessed using GRADE ConQual. A total of 921 records were identified, but only five studies were included. The overall methodological quality of these studies was good and GRADE ConQual assessment score was "moderate." Fear of negative consequences was the most cited barrier to nursing incident reporting. Barriers also included inadequate incident reporting systems and lack of interdisciplinary and interdepartmental cooperation. Lack of nurses' necessary training made it more difficult to understand the importance of incident reporting and the definition of error. Lack of effective feedback and motivation and a pervasive blame culture were also identified.

Development of a theoretical framework of factors affecting patient safety incident reporting: a theoretical review of the literature

OBJECTIVES

The development and implementation of incident reporting systems within healthcare continues to be a fundamental strategy to reduce preventable patient harm and improve the quality and safety of healthcare. We sought to identify factors contributing to patient safety incident reporting.

DESIGN

To facilitate improvements in incident reporting, a theoretical framework, encompassing factors that act as barriers and enablers ofreporting, was developed. Embase, Ovid MEDLINE(R) and PsycINFO were searched to identify relevant articles published between January 1980 and May 2014. A comprehensive search strategy including MeSH terms and keywords was developed to identify relevant articles. Data were extracted by three independent researchers; to ensure the accuracy of data extraction, all studies eligible for inclusion were rescreened by two reviewers.

RESULTS

The literature search identified 3049 potentially eligible articles; of these, 110 articles, including >29 726 participants, met the inclusion criteria. In total, 748 barriers were identified (frequency count) across the 110 articles. In comparison, 372 facilitators to incident reporting and 118 negative cases were identified. The top two barriers cited were fear of adverse consequences (161, representing 21.52% of barriers) and process and systems of reporting (110, representing 14.71% of barriers). In comparison, the top two facilitators were organisational (97, representing 26.08% of facilitators) and process and systems of reporting (75, representing 20.16% of facilitators).

CONCLUSION

A wide range of factors contributing to engagement in incident reporting exist. Efforts that address the current tendency to under-report must consider the full range of factors in order to develop interventions as well as a strategic policy approach for improvement.

Experiences of and support for nurses as second victims of adverse nursing errors: a qualitative systematic review

BACKGROUND

Second victims are clinicians who have made adverse errors and feel traumatized by the experience. The current published literature on second victims is mainly representative of doctors, hence nurses' experiences are not fully depicted. This systematic review was necessary to understand the second victim experience for nurses, explore the support provided, and recommend appropriate support systems for nurses.

OBJECTIVES

To synthesize the best available evidence on nurses' experiences as second victims, and explore their experiences of the support they receive and the support they need.

INCLUSION CRITERIA PARTICIPANTS

Participants were registered nurses who made adverse errors.

PHENOMENA OF INTEREST

The review included studies that described nurses' experiences as second victims and/or the support they received after making adverse errors.

CONTEXT

All studies conducted in any health care settings worldwide.

TYPES OF STUDIES

The qualitative studies included were grounded theory, discourse analysis and phenomenology.

SEARCH STRATEGY

A structured search strategy was used to locate all unpublished and published qualitative studies, but was limited to the English language, and published between 1980 and February 2017. The references of studies selected for eligibility screening were hand-searched for additional literature.

METHODOLOGICAL QUALITY

Eligible studies were assessed by two independent reviewers for methodological quality using a standardized critical appraisal instrument from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI QARI).

DATA EXTRACTION

Themes and narrative statements were extracted from papers included in the review using the standardized data extraction tool from JBI QARI.

DATA SYNTHESIS

Data synthesis was conducted using the Joanna Briggs Institute meta-aggregation approach.

RESULTS

There were nine qualitative studies included in the review. The narratives of 284 nurses generated a total of 43 findings, which formed 15 categories based on similarity of meaning. Four synthesized findings were generated from the categories: (i) The error brings a considerable emotional burden to the nurse that can last for a long time. In some cases, the error can alter nurses' perspectives and disrupt workplace relations; (ii) The type of support received influences how the nurse will feel about the error. Often nurses choose to speak with colleagues who have had similar experiences. Strategies need to focus on helping them to overcome the negative emotions associated with being a second victim; (iii) After the error, nurses are confronted with the dilemma of disclosure. Disclosure is determined by the following factors: how nurses feel about the error, harm to the patient, the support available to the nurse, and how errors are dealt with in the past; and (iv) Reconciliation is every nurse's endeavor. Predominantly, this is achieved by accepting fallibility, followed by acts of restitution, such as making positive changes in practice and disclosure to attain closure (see "Summary of findings").

CONCLUSION

Adverse errors were distressing for nurses, but they did not always receive the support they needed from colleagues. The lack of support had a significant impact on nurses' decisions on whether to disclose the error and his/her recovery process. Therefore, a good support system is imperative in alleviating the emotional burden, promoting the disclosure process, and assisting nurses with reconciliation. This review also highlighted research gaps that encompass the characteristics of the support system preferred by nurses, and the scarcity of studies worldwide.

Investigating the cost and efficiency of incident reporting in a specialist paediatric NHS hospital and impact on patient safety

Objectives

The aim of this study was to investigate the incident reporting process (IR1s), to calculate the costs of reporting incidents in this context and to gain an indication of how economic the process was and whether it could be improved to yield better outcomes.

Methods

A retrospective analysis of a sample, 10.47% (n=150) selected from 1432 medication incident report summaries, generated at Birmingham Children's Hospital, a specialist tertiary referral paediatric centre, during 2014 and collated through the national Datix incident reporting system software was analysed and the associated staff time required to complete each step of the incident reporting process was costed. The staff costs for various grades of staff were averaged across the staff actually involved, using data calculated by the Personal Social Services Research Unit.

Results

The analysis showed that the incident reporting process involved 262 staff on 2942 occasions (19.16 staff episodes per incident form completed) at a cost of £337.16 per incident form completed.

Conclusions

The study showed that the incident reporting system was a labour intensive process. The numbers of staff involved in the process particularly as a result of the email distribution activity did appear to have room for efficiencies. However, it proved to be relatively inexpensive from a cost perspective. With redesign, arguably the emphasis could be moved away from the recording process to learning in order to gain improved patient safety outcomes.