Exploration of the barriers of reporting nursing errors in intensive care units: A qualitative study

An Exploration of Nurses' Attitudes and Beliefs on Reporting Medication Errors

BACKGROUND

Medication errors in health care are prevalent. Nurses play an important role in reporting; however errors remain underreported in incident reporting systems. Understanding the perspective of nurses will inform strategies to improve reporting and build systems to reduce errors.

PURPOSE

The purpose of this study was to explore nurses' perceptions and attitudes of medication error reporting practices.

METHODS

This qualitative study used direct content analysis to analyze interview sessions with 21 total nurses.

RESULTS

Participant's description of medication error reporting practices fell into 2 themes. Internal factors described circumstances within nurses themselves that affect reporting. External factors described outside influences from processes or places.

CONCLUSIONS

Medication error reporting is a multidimensional phenomenon with internal and external factors impacting nurses' attitudes and willingness to report errors. Nurses need support from leadership to understand that reporting medication errors can improve practice and impact patient outcomes.

Understanding an epidemiological view of a retrospective audit of medication errors in an intensive care unit

BACKGROUND

Medication errors in the intensive care setting continue to occur at significant rates and are often associated with adverse events and potentially life-threatening repercussions.

AIM/OBJECTIVE

The aim of this study was to (i) determine the frequency and severity of medication errors reported in the incident management reporting system; (ii) examine the antecedent events, their nature, the circumstances, risk factors, and contributing factors leading to medication errors; and (iii) identify strategies to improve medication safety in the intensive care unit (ICU).

METHOD

A retrospective, exploratory, descriptive design was selected. Retrospective data were collected from the incident report management system and electronic medical records over a 13-month period from a major metropolitan teaching hospital ICU.

RESULTS

A total of 162 medication errors were reported during a 13-month period, of which, 150 were eligible for inclusion. Most medication errors occurred during the administration (89.4%) and dispensing phases (23.3%). The highest reported errors included incorrect doses (25.3%), incorrect medications (12.7%), omissions (10.7%), and documentation errors (9.3%). Narcotic analgesics (20%), anaesthetics (13.3%), and immunomodifiers (10.7%) were the most frequently reported medication classes associated with medication errors. Prevention strategies were found to be focussed on active errors (67.7%) as opposed to latent errors (32.3%) and included various and infrequent levels of education and follow-up. Active antecedent events included action-based errors (39%) and rule-based errors (29.5%), whereas latent antecedent events were most associated with a breakdown in system safety (39.3%) and education (25%).

CONCLUSION

This study presents an epidemiological view and understanding of medication errors in an Australian ICU. This study highlighted the preventable nature of most medication errors in this study. Improving administration-checking procedures would prevent the occurrence of many medication errors. Approaches aimed at both individual- and organisational-level improvements are recommended to address administration errors and inconsistent medication-checking procedures. Areas for further research include determining the most effective system developments for improving administration-checking procedures and verifying the risk and prevalence of immunomodifier administration errors in the ICU as this is an area not reported previously in the literature. In addition, the impact of single- versus two-person checking procedures on medication errors in the ICU should be prioritised to address current evidence gaps.

Nursing students' handling patient safety incidents during clinical practice: A retrospective qualitative study

BACKGROUND

Nursing students may encounter patient safety incidents during clinical practice. Understanding the challenges and concerns of nursing students in handling with patient safety incident could contribute to informing nursing education and clinical practice training.

OBJECTIVES

The aim of this study was to investigate how nursing students handle patient safety incidents during clinical practice.

DESIGN

A retrospective descriptive qualitative study.

SETTING

Nursing school in Slovenia.

PARTICIPANTS

A snowball sampling technique was used to recruit nursing students (n = 15).

METHODS

Data were collected via guided self-reflection diaries in 2021. Collected data were analysed using thematic analysis.

RESULTS

We have generated the main theme of nursing students' handling patient safety incidents during clinical practice. The four primary thematic subthemes were: (1) emotional responses; (2) patient safety incident occurrence and actions taken; (3) contributing factors; and (4) consequences.

CONCLUSIONS

Our study highlights nursing students' handling of patient safety incidents during clinical practice, revealing a spectrum of emotional responses, immediate actions, contributing factors, consequences, and the importance of fostering a non-blaming culture through reporting and effective communication.

Clinical incident reporting behaviors and associated factors among health professionals in Dessie comprehensive specialized hospital, Amhara Region, Ethiopia: a mixed method study

Background

Understanding the type and causes of errors are necessary for the prevention of occurrence or reoccurrence. Therefore addressing the behavior of health professionals on reporting clinical incidents is crucial to create spontaneous knowledge from mistakes and enhance patient safety.

Method

A mixed type institution-based cross-sectional study design was conducted from March 1 - 30, 2020 in Dessie comprehensive specialized hospital among 319 and 18 participants for the quantitative and qualitative study, respectively. The professions and participants with their assigned proportions were selected using a simple random sampling technique. For quantitative and qualitative data, semi structured questionnaires and interviewer-guided questions were used to collect data, respectively. Finally, qualitative findings were used to supplement the quantitative result.

Result

The finding showed that the proportion of clinical incident reporting behavior among health professionals was 12.4%. Having training (AOR=3.6, 95% CI, 1.15-11.45), incident reporting help to minimize errors (AOR=2.8, 95% CI, 1.29-6.02), fear of legal penalty (AOR= 0.3, 95% CI, 0.13-0.82), and lack of feedback (AOR=0.3, 95% CI, 0.11-0.90) were identified as significant factors for clinical incident reporting behavior of the health professionals.

Conclusions

This study showed that the clinical incident reporting behavior of the health professionals was very low. Therefore health professionals should get training on clinical incident reporting and the hospital should have an incident reporting system and guideline.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07350-y.

Nurses' experiences in voluntary error reporting: An integrative literature review

OBJECTIVE

This integrative review aimed to examine and understand nurses' experiences of voluntary error reporting (VER) and elucidate factors underlying their decision to engage in VER.

METHOD

This is an integrative review based on Whittemore & Knafl five-stage framework. A systematic search guided by the PRISMA 2020 approach was performed on four electronic databases: CINAHL, Medline (PubMed), Scopus, and Embase. Peer-reviewed articles published in the English language from January 2010 to December 2020 were retrieved and screened for relevancy.

RESULTS

Totally 31 papers were included in this review following the quality appraisal. A constant comparative approach was used to synthesize findings of eligible studies to report nurses' experiences of VER represented by three major themes: nurses' beliefs, behavior, and sentiments towards VER; nurses' perceived enabling factors of VER and nurses' perceived inhibiting factors of VER. Findings of this review revealed that nurses' experiences of VER were less than ideal. Firstly, these negative experiences were accounted for by the interplays of factors that influenced their attitudes, perceptions, emotions, and practices. Additionally, their negative experiences were underpinned by a spectrum of system, administrative and organizational factors that focuses on attributing the error to human failure characterized by an unsupportive, blaming, and punitive approach to error management.

CONCLUSION

Findings of this review add to the body of knowledge to inform on the areas of focus to guide nursing management perspectives to strengthen institutional efforts to improve nurses' recognition, reception, and contribution towards VER. It is recommended that nursing leaders prioritize and invest in strategies to enhance existing institutional error management approaches to establish a just and open patient safety culture that would promote positivity in nurses' overall experiences towards VER.

Development and preliminary psychometric evaluation of a nursing error tool in critical care units

OBJECTIVE

This study was conducted to address the importance of identifying nursing errors in critical care units and the lack of appropriate tools for measuring them. This study aimed to develop and psychometrically evaluate a nursing error tool in critical care units.

DESIGN

This was a psychometric validity study.

SETTING

The study involved eight critical care units affiliated with Kurdistan University of Medical Sciences.

METHODS

The research was conducted in two phases. In the first phase, data were gathered via interviews with nurses, and analyzed with conventional content analysis. The primary codes and subcategories were identified as tool items. In the second phase, the psychometric properties of the instrument, including face validity, content validity, construct validity, internal consistency, and reliability were investigated.

RESULTS

In the first phase, 142 items were extracted; this number was reduced to 40 items after assessing qualitative content validity. Exploratory factor analysis identified five factors: medication error, task description error, executive error, procedural error, and safety error, which made up 88% of the total variance. The Cronbach's alpha was 0.97.

CONCLUSIONS

The development of a validated nursing error tool is helpful in identifying the extent and typologies of nursing errors, and could aid in designing better prevention strategies in critical care units.

Critical Incidents Involving the Medical Emergency Team: A 5-Year Retrospective Assessment for Healthcare Improvement

BACKGROUND

Medical emergency teams (METs), which have been established in several countries, contribute to a reported decrease in deteriorated patients' in-hospital mortality. To date, no data have been published on critical incidents that occurred in METs affecting patients' safety.

OBJECTIVES

The aim of the study was to identify and describe critical incidents that occurred during METs' activities in a large academic Italian hospital.

METHODS

The data, which were stored in the official incident reporting system of the hospital and included all critical incidents that occurred and were reported in anonymous and voluntary forms over a 5-year period, were retrospectively analyzed.

RESULTS

Overall, 17 critical incidents emerged, during both the team alert stage (n = 10) and its performance (n = 7), with approximately 3 events per year and an incident rate of 1.7 for every 1000 MET interventions.

DISCUSSION

Medical emergency teams' critical incidents are rare and mainly due to the lack of compliance with protocols and of training and supplies, which require appropriate educational and organizational strategies.

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.

Critical Incident Disclosing Behaviors and Associated Factors among Nurses Working in Amhara Region Referral Hospitals, Northwest Ethiopia: A Cross-Sectional Study

Background

Though the goal of healthcare institutions is patient safety, errors have been committed by healthcare providers. Incident reporting behavior enhances patient safety by reducing the repeated occurrence of errors in the health facility. Therefore, this study aims to identify incident disclosing behaviors and associated factors among nurses working in referral hospitals, Northwest Ethiopia.

Methods

Institution-based cross-sectional study design was conducted among randomly selected 319 nurses working in referral hospitals of Amhara region from March 1-30, 2019. Data were collected using a self-administered structured questionnaire. Data were coded and entered into EpiData 4.2 software and exported to Statistical Package for Social Sciences version 25 for analysis. All variables with p value <0.25 during bivariable binary logistic regression analysis were considered for multivariable binary logistic regression analysis. Odds ratio along with 95% CI was estimated to measure the strength of the association. Level of statistical significance was declared at p value ≤0.05.

Results

The proportion of nurses who reported incidents was 31.9% (95% confidence interval (CI), 27, 3)). Fear of administrative sanctions (adjusted odd ratio (AOR) = 0.45; 95% CI, 0.22, 0.90), fear of legal penalty (AOR = 0.27; 95% CI, 0.14, 0.50), lack of feedback (AOR = 0.29; 95% CI, 0.13, 0.66), nonsupportive environment (AOR = 0.27; 95% CI, 0.14, 0.52), and feel that reporting to colleague is easier (AOR = 2.65; 95% CI, 1.35, 5.20) were all found to be significant factors.

Conclusions

The proportion of nurses who reported incidents was low. Fear of administrative sanctions, fear of legal penalty, lack of feedback, nonsupportive environment, and felling that reporting to colleagues was easier are found to be significant factors. Developing a system that encourages critical incident reporting behavior and provide protection from penalties for nurses to report incidents for the enhancement of patient safety and quality of care at each health facility and regional level is crucial.

Moral neutralization: Nurses' evolution in unethical climate workplaces

Introduction

Good quality of care is dependent on nurses’ strong clinical skills and moral competencies, as well. While most nurses work with high moral standards, the moral performance of some nurses in some organizations shows a deterioration in their moral sensitivity and actions. The study reported in this paper aimed to explore the experiences of nurses regarding negative changes in their moral practice.

Materials and methods

This was a qualitative study utilizing an inductive thematic analysis approach, which was conducted from February 2017 to September 2019. Twenty-five nurses participated in semi-structured interviews.

Results

The main theme that emerged from our analysis was one of moral neutralization in the context of an unethical moral climate. We found five sub-themes, including: (1) feeling discouraged; (2) normalization; (3) giving up; (4) becoming a justifier; and (5) moral indifference.

Conclusions

Unethical moral climates in health organizations can result in deterioration of morality in nurses which can harm both patients and health systems. Some unethical behaviors in nurses can be explained by this process.

Critical incidents rates and types in Italian Intensive Care Units: A five-year analysis

OBJECTIVE

To describe rates and types of critical incidents in Intensive Care Units.

RESEARCH METHODOLOGY

A retrospective study in four intensive care units of an Academic Hospital located in the North-East of Italy. All critical incidents recorded in an incident reporting system database from 2013 to 2017 were collected.

RESULTS

160 critical incidents emerged. The rate was 1.7/100 intensive care-patient admissions, and 2.86/1000 in intensive care-patient days. Nurses reported most of the critical incidents (n = 113, 70.6%). In 2013 there were 19 (11.9%) critical incidents which significantly increased by 2017 (n = 38, 23.7%; p = 0.034). The most frequent critical incidents were medication/intravenous fluids issues (n = 35, 21.9%) and resources and organisational management (n = 35, 21.9%). Less frequently occurring incidents concerned medical devices/equipment (n = 29, 18.1%), clinical processes/procedures (n = 18, 11.3%), documentation (n = 14, 8.8%) and patient accidents (n = 13, 8.1%). Rare incidents included behaviour, clinical administration, nutrition, blood products and healthcare associated infection.

CONCLUSION

Over a five-year period, documented incidents were steadily increasing in four Italian intensive care units. A voluntary incident reporting system might provide precious information on safety issues occurring in units. at both policy and professional levels.

Factors affecting nursing error communication in intensive care units: A qualitative study

BACKGROUND

Error communication includes both reporting errors to superiors and disclosing their consequences to patients and their families. It significantly contributes to error prevention and safety improvement. Yet, some errors in intensive care units are not communicated.

OBJECTIVES

The aim of the present study was to explore factors affecting error communication in intensive care units.

DESIGN AND PARTICIPANTS

This qualitative study was conducted in 2019. Participants were 17 critical care nurses purposively recruited from the intensive care units of 2 public hospitals affiliated to Iran University of Medical Sciences, Tehran, Iran. Data were collected through in-depth semi-structured interviews and were analyzed through the conventional content analysis method proposed by Graneheim and Lundman.

ETHICAL CONSIDERATIONS

The Ethics Committee of Iran University of Medical Sciences, Tehran, Iran approved the study (code: IR.IUMS. REC.1397.792). Participants were informed about the study aim and methods and were ensured of data confidentiality. They were free to withdraw from the study at will. Written informed consent was obtained from all of them.

FINDINGS

Factors affecting error communication in intensive care units fell into four main categories, namely the culture of error communication (subcategories were error communication organizational atmosphere, clarity of processes and guidelines, managerial support for nurses, and learning organization), the consequences of errors for nurses and nursing (subcategories were fear over being stigmatized as incompetent, fear over punishment, and fear over negative judgments about nursing), the consequences of errors for patients (subcategories were monitoring the effects of errors on patients and predicting the effects of errors on patients), and ethical and professional characteristics (subcategories were ethical characteristics and inter-professional relationships).

DISCUSSION

The results of this study show many factors affect error communication, some facilitate and some prohibit it. Organizational factors such as the culture of error communication and the consequences of error communication for the nurse and the patient, as well as individual and professional characteristics, including ethical characteristics and interprofessional relationship, influence this process.

CONCLUSION

Errors confront nurses with ethical challenges and make them assess error consequences and then, communicate or hide them based on the results of their assessments. Health authorities can promote nurses' error communication through creating a supportive environment for them, developing clear error communication processes and guidelines, and providing them with education about the principles of ethical practice.

The Relationship between Patient Safety Climate and Medical Error Reporting Rate among Iranian Hospitals Using a Structural Equation Modeling

Background

Improving patient safety is a global health imperative, and patient safety climate is one of the components one that plays an important role in promoting patient safety. Medical error reporting is a way through which it can be evaluated and prevented in the future. The aim of this study was to assess the relationship between patient safety climate and medical error reporting in military and civilian hospitals.

Methods

This research was conducted by using structural equation modeling in the selected hospitals of Iran in 2018. The study community consisted of 200 nurses in the military and 400 nurses in the civilian hospitals. By using Structural Equation Modeling, the relationship between patient safety climate and the rate of medical error reporting in the hospitals was measured by a questionnaire. Data was analyzed using SPSS 17 and LISREL 8.8 software.

Results

The mean score of patient safety climate was moderate in the hospitals. There was no significant relationship between the rate of medical error reporting and patient safety climate, while a significant difference was found between patient safety climate score and age, sex, job category, and type of hospital (P < 0.05).

Conclusion

The results suggested that patient safety climate and the rate of reporting errors were not favorable in the studied hospitals, while there was a difference between safety climate dimensions.

Medication errors among Iranian emergency nurses: A systematic review

OBJECTIVES

Medication errors (MEs) made by nurses are the most common errors in emergency departments (EDs). Identifying the factors responsible for MEs is crucial in designing optimal strategies for reducing such occurrences. The present study aimed to review the literature describing the prevalence and factors affecting MEs among emergency ward nurses in Iran.

METHODS

We searched electronic databases, including the Scientific Information Database, PubMed, Cochrane Library, Web of Science, Scopus, and Google Scholar, for scientific studies conducted among emergency ward nurses in Iran. The studies were restricted to full-text, peer-reviewed studies published from inception to December 2019, in the Persian and English languages, that evaluated MEs among emergency ward nurses in Iran.

RESULTS

Eight studies met the inclusion criteria. Most of the nurses (58.9%) had committed MEs only once. The overall mean rate of MEs was 46.2%, and errors made during drug administration accounted for 41.7% of MEs. The most common type of administration error was drug omission (17.8%), followed by administering drugs at the wrong time (17.5%) and at an incorrect dosage (10.6%). The lack of an adequate nursing workforce during shifts and improper nurse-patient ratios were the most critical factors affecting the occurrence of MEs by nurses.

CONCLUSIONS

Despite the increased attention on patient safety in Iran, MEs by nurses remain a significant concern in EDs. Therefore, nurse managers and policy-makers must take adequate measures to reduce the incidence of MEs and their potential negative consequences.

Recommendations to prevent nursing errors: Content analysis of semi-structured interviews with intensive care unit nurses in a developing country

AIM

To elicit intensive care unit (ICU) nurses' recommendations to prevent nursing errors.

BACKGROUND

Errors are usually induced by faulty systems, and managers play a key role in building a safe health care system.

METHOD

A qualitative research design was used. Semi-structured interviews with 112 Egyptian ICU nurses were conducted, and responses were analysed using qualitative content analysis.

RESULTS

Responses from 108 nurses were analysed. Six themes of recommendations were identified: improvement and better organisation of resources, policy modification, education and training, likeness minimization, use of technology and work environment changes.

CONCLUSION

Nurses' recommendations reflect the poor-resource context in developing countries. Several recommendations, however, are relatively cheap to implement strategies.

IMPLICATIONS FOR NURSING MANAGEMENT

All reported recommendations are organisational issues. Improvement and better organisation of human and non-human resources is a priority issue to prevent or minimize nursing errors. Policy modification, education and training, and likeness minimization are relatively cheap, easy-to-implement strategies to tackle the occurrence of nursing errors in developing countries. Staff nurses should be actively involved in policy reform. Patient safety education should be supported by adopting modern technology and work environment reform.

What influences nursing safety event reporting among nursing interns?: Focus group study

BACKGROUND

Nursing safety events involving undergraduate nursing interns often occur but are under-reported. Only a few nursing schools have instituted formal reporting systems. The factors that affect reporting by undergraduate nursing interns are largely unknown.

OBJECTIVE

The study aimed to explore the barriers and incentives to nursing safety event reporting by nursing interns.

DESIGN

Focus groups were adopted to generate data for qualitative, thematic analyses.

SETTINGS

Focus groups were held in intern dormitories during evenings or weekends.

PARTICIPANTS

Purposive sampling strategies were employed. The participants were undergraduate nursing interns from one medical university in Fuzhou, China.

METHODS

A total of six focus groups were conducted. Semi-structured questions guided the groups.

RESULTS

Thirty-eight undergraduate nursing interns attended the groups. Barriers to nursing safety event reporting had five major themes: "Lack of knowledge," "Inconvenience of the reporting system," "Feeling of uncertainty and dishonor," "No benefit from reporting," and "Social influence." Incentives had three major themes: "Nursing safety event education," "Optimization of the reporting system," and "Anonymous reporting." Specific and targeted suggestions were considered, such as education by QQ or WeChat and the use of mobile devices.

CONCLUSIONS

Nursing schools need to establish nursing safety event reporting systems for interns, and this needs to be accomplished in cooperation with teaching hospitals to clarify duties and management responsibilities. Practical and targeted management strategies need to be developed to foster reporting, improve nursing safety culture, and promote hospital quality.

Nurses' families' experiences of involvement in nursing errors: A qualitative study

Background

The most important and irreversible consequence of medical errors is the human impact caused by unintended actions. In a few studies, the significant impact of this error on the private life of healthcare staff have been mentioned, but the problems of the involved nurses' families had been ignored, as of now.

Aims

This study aimed to explain the nurses' families' experiences of involvement in nursing errors.

Methods

This is a qualitative study using conventional content analysis with 20 semi-structured interviews conducted with nurses and family members of nurses involved in medical errors, done through purposeful sampling and willingness to participate in the study.

Results

The results of the data analysis consisted of five main categories including disruption in family functioning, the crisis of fear, oppression, damage, and neglect, along with 15 subcategories.

Conclusion

Considering the effects of nursing errors on the families of nurses involved in the error, such as disruption of family functioning, the family of nurses involved in the error should also be considered and paid attention to. These families are abandoned and the need to promote the culture of supporting the family is tangible.