Unreported Errors in the Intensive Care Unit

Design of a Wearable Stress Monitoring Tool for Intensive Care Unit Nursing: Functional Information Requirements Analysis

Nurses are the last line of defense to reduce preventable medical errors; however, they suffer from poor systems design and human factors issues (e.g., long shifts, dynamic workload, stressful situations, and fatigue), contributing to a reduced quality of care. A smart nursing system based on physiological monitoring is being designed to help nurses and their managers to efficiently communicate, reduce interruptions that affect critical task performance, and monitor acute stress and fatigue levels. This paper documents the systematic process of deriving information requirements through a group-participatory usability study, conducted with nurses working in various Southeastern Texas hospitals. Information requirements derived from these studies include: a need for accessing patients’ vital signs as well as laboratory results, memory aid tools for various critical nursing tasks, and options to call for help and to reduce interruptions for critical tasks. The system shows promise to meet these requirements.

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

AIM

The aim of this study was to explore the barriers to reporting nursing errors in intensive care units in Iranian hospitals.

METHODS

A descriptive qualitative analysis design was used. The data were collected through in-depth semi-structured interviews with a purposive sample of 16 nurses working in four general intensive care units in Kurdistan province, Iran. Interviews were transcribed and finally analysed through conventional content analysis.

RESULTS

There are four major barriers to the reporting of errors by nurses working in Iranian critical care units: (a) saving professional reputation and preventing stigma; (b) fear of consequences - punishment, legal problems and organisational misconduct; (c) feelings of insecurity - pointing a finger at nurses and lack of managerial support and (d) not investigating the root cause of error.

CONCLUSIONS

The findings revealed the need to support and provide security to nurses and to consider and find the cause of error occurrence. Managers must provide the required personal, professional and legal support for nurses to encourage them to effectively report errors, discover the root cause of errors and take measures to prevent them.

Incorporating best practices into undergraduate critical care nursing education

Incorporation of best clinical practices into the baccalaureate critical care nursing curriculum is important. At The College at Brockport, best clinical practices are introduced early in the semester and are reinforced throughout the semester in both class and clinical settings. Among the best clinical practices included are those recommended by the American Association of Critical-Care Nurses, The Centers for Medicare and Medicaid Services, the Institute for Healthcare Improvement, The Joint Commission, Quality and Safety Education for Nurses, the Surviving Sepsis Campaign, and the Institute for Safe Medication Practices. The culminating assignment of the semester requires students to focus on patient safety. Students describe the use of the National Patient Safety Goals and other best practices in the critical care setting. The role of the nurse leader and exploration of near-miss and work-around events also are described. Nursing students need to provide safe competent nursing care by incorporating best practices into their clinical practice now and in the future when they become registered professional nurses.

The culture of patient safety in an Iranian intensive care unit

AIM

To explore nurses' and physicians' attitudes and perceptions relevant to safety culture and to elicit strategies to promote safety culture in an intensive care unit.

BACKGROUND

A strong safety culture is essential to ensure patient safety in the intensive care unit.

METHOD

This case study adopted a mixed method design. The Safety Attitude Questionnaire (SAQ-ICU version), assessing the safety climate through six domains, was completed by nurses and physicians (n = 42) in an academic intensive care unit. Twenty semi-structured interviews and document analyses were conducted as well. Interviews were analysed using a framework analysis method.

RESULT

Mean scores across the six domains ranged from 52.3 to 72.4 on a 100-point scale. Further analysis indicated that there were statistically significant differences between physicians' and nurses' attitudes toward teamwork (mean scores: 64.5/100 vs. 52.6/100, d = 1.15, t = 3.69, P < 0.001) and job satisfaction (mean scores: 78.2/100 vs. 57.7/100, d = 1.5, t = 4.8, P < 0.001). Interviews revealed several safety challenges including underreporting, failure to learn from errors, lack of speaking up, low job satisfaction among nurses and ineffective nurse-physician communication.

CONCLUSION

The results indicate that all the domains need improvements. However, further attention should be devoted to error reporting and analysis, communication and teamwork among professional groups, and nurses' job satisfaction.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers can contribute to promoting a safety culture by encouraging staff to report errors, fostering learning from errors and addressing inter-professional communication problems.

Integration of evidence-based knowledge management in microsystems: a tele-ICU experience

The Institute of Medicine's proposed 6 aims to improve health care are timely, safe, effective, efficient, equitable, and patient-centered care. Unfortunately, it also asserts that improvements in these 6 dimensions cannot be achieved within the existing framework of care systems. These systems are based on unrealistic expectations on human cognition and vigilance, and demonstrate a lack of dependence on computerized systems to support care processes and put information at the point of use. Knowledge-based care and evidence-based clinical decision-making need to replace the unscientific care that is being delivered in health care. Building care practices on evidence within an information technology platform is needed to support sound clinical decision-making and to influence organizational adoption of evidence-based practice in health care. Despite medical advances and evidence-based recommendations for treatment of severe sepsis, it remains a significant cause of mortality and morbidity in the world. It is a complex disease state that has proven difficult to define, diagnose, and treat. Supporting bedside teams with real-time knowledge and expertise to target early identification of severe sepsis and compliance to Surviving Sepsis Campaign, evidence-based practice bundles are important to improving outcomes. Using a centralized, remote team of expert nurses and an open-source software application to advance clinical decision-making and execution of the severe sepsis bundle will be examined.

Nurses' perceptions of patient safety climate in intensive care units: a cross-sectional study

OBJECTIVES

To investigate registered nurses' perceptions of the patient safety climate in intensive care units and to explore potential predictors for overall perception of safety and frequency of incident reporting.

RESEARCH METHODOLOGY/DESIGN

A cross-sectional design was conducted, using the questionnaire Hospital Survey on Patient Safety Culture, measuring 12 patient safety climate dimensions: seven at unit and three at hospital level, two outcomes and in addition two outcome items.

SETTING

Ten intensive care units (ICUs) in six hospitals in one hospital trust in Norway.

RESULTS

In total, 220 registered nurses (RNs) responded (72%). Seven of 12 dimensions achieved a RN proportion of positive scores over 55%. Five achieved a lower proportion. Significant differences in RNs' perceptions of patient safety were found between types of units and between the four hospitals. The total variance in the outcome measure explained by the model as a whole was for the outcome dimensions "overall perception of safety" 32%, and "frequency of incident reporting" 32%. The variables at the unit level made a significant contribution to the outcome.

CONCLUSION

RNs in ICU are most positive to patient safety climate at unit level, hence improvements are needed concerning incident reporting, feedback and communication about errors and organisational learning and continuous improvement.

[Adverse events at the Intensive Care Unit: nurses' perception about the culture of no-punishment]

The safety culture of Intensive Care Units (ICU) recommends following the no-punishment approach when adverse events (AE) occur. It is, however, questionable if nurses perceive those AE.

OBJECTIVES

to characterize AE report systems; to verify AE frequency and consequences to the professionals; and to verify the nurses' level of confidence to report AE. This descriptive study involved 70 ICU nurses, who answered a questionnaire in 2007, followed by descriptive analyses. Most nurses (70.0%) reported the existence of an AE notification system at their place of work. The frequency of AE was reported as sometimes and several times by 51.4% and 28.6% of the sample, respectively. For 74.3% of nurses, punishment happens sometimes and always, mainly through verbal notice (49.0%). Most nurses (74.3%) reported feeling confident and completely confident to report AE. In conclusion, punishment still exists in the Units.

The nurse-nurse collaboration scale

OBJECTIVE

To develop and examine the reliability and validity of a new instrument, the nurse-nurse collaboration (NNC) scale.

BACKGROUND

Nurse-nurse collaboration (NNC) is recommended to reduce medical errors and improve patient care and nurses' job satisfaction. While instruments are available to measure nurse-physician collaboration, an instrument to measure NNC was not available in the literature. Because collaboration is necessary for optimal patient care, a valid and reliable instrument would make it possible to measure the level of collaboration among nurses.

METHODS

A comprehensive literature review was conducted to develop a definition and define relevant domains of NNC and identify instruments with acceptable psychometrics that included items measuring NNC. Instrument items to develop the Nurse-Nurse Collaboration Scale (NNC Scale) were adapted from previously published tools or developed based on domains identified in the literature. Five domains were identified: problem solving, communication, coordination, shared process, and professionalism. Psychometric testing of the NNC Scale included pilot testing for content and construct validity and field testing among 76 staff nurses working in 4 ICUs in a large tertiary-care academic medical center in the northeast United States. Psychometric tests assessing reliability and convergent validity correlations were conducted.

RESULTS

The overall Cronbach alpha for the scale was .89. Convergent validity correlations, however, were low to moderate, indicating minimal shared variance among the subscales. Therefore, the instrument did not measure a global concept but rather 5 separate domains of collaboration. Internal consistency testing of the 5 subscales produced acceptable results ranging from .66 to .91.

CONCLUSION

The NNC Scale demonstrated acceptable reliability and validity for measuring the level of NNC in intensive care nurses. Further psychometric testing and a factor analysis with a larger-sample, more diverse groups of nurses are necessary to further characterize the generalizability of the NNC Scale.