Journal of Neuroscience Nursing:
Carroll, V. Susan Editor
Easily understood or recognized. Very clear. Openness. Frankness. Without guile. These words sum up the characteristics of transparency. Today, transparency has become an increasingly important component of safety programs designed to improve patient care. Although many institutions have implemented programs and processes that support open sharing of publicly reported performance measures, transparency related to nursing and medical errors has proven to be more elusive. Even in hospitals that espouse a “just culture” that is nonpunitive, adverse event reporting varies widely among healthcare professionals.
A 2010 study conducted at a large, urban hospital in Scotland examined attitudes of 3 groups of healthcare professionals—nurses, doctors, and pharmacists—relative to the reporting of medication errors (Sarvadikar, Prescott, & Williams, 2010). Using clinical scenarios and a questionnaire that ranked worsening patient outcomes, the investigators found that the type and severity of errors influenced differences in reporting. Despite the belief that they were likely to be blamed for an error, nurses and pharmacists were more likely than physicians to report all errors despite the degree of adverse outcomes. In addition, although nurses expressed a greater expression of disciplinary action, they believed that reporting is essential for identifying system faults that lead to errors and creates a safer clinical practice arena.
Because we care for patients who are often at their most vulnerable, neuroscience nurses should embrace efforts to practice transparently. Many of us work in institutions that have adopted disclosure, apology, and offer (DA&O) programs, settings that ask us to openly talk about our mistakes or safety lapses, to apologize, and to make amends (these need not be financial). Early supporters of DA&O programs report as much as a 60% decrease in legal and compensation costs (Kachalia et al., 2010). Transparency should occur not simply because it is a “good” thing in and of itself but because it is the ethical choice.
How can each of us support transparency? How can we allay our own and our colleagues’ fears about making, and then reporting, a simple human error? How can we balance the need for individual accountability with guidelines for the best, safest practice? Look at the evidence that supports that best practice. Just doing what we’ve always done can’t guide our practice today. Look for systems gaps and faults that put our patients and ourselves at risk. Support your peers as they learn and grow professionally. It’s tough to be a novice. Learn to report just the facts—no interpretation, no subtle judgments. Teach your patients about their care, the plans for acute and long-term needs. Help your patients develop realistic expectations related to outcomes. Talk to patients; listen to them. Teach them to trust you. Commit to openness. Finally, to quote Andrew Kantor, the former Editor of Computer World and an information guru, “There’s no going back, and there’s no hiding the information. So let everyone have it” (http://www.goodreads.com/quotes/search?utf8=%E2%9C%93&q=andrew+kantor&commit=Search, accessed December 19, 2013).
The Editor declares no conflicts of interest.
Kachalia A., Kaufman S. R., Boothman R., Anderson S., Welch K., Rogers M. A. (2010). Liability claims and costs before and after implementation of a medical error disclosure program. Annals of Internal Medicine, 153, 213–221.
Sarvadikar A., Prescott G., Williams D. (2010). Attittudes to reporting medication error among differing healthcare professionals. European Journal of Clinical Pharmacology, 66 (8), 843–853. doi:10.1007/s00228-010-0838-x