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Nurses' Perceptions of Error Communication and Reporting in the Intensive Care Unit

Elder, Nancy C. MD, MSPH*; Brungs, Suzanne M. MSN, MBA; Nagy, Mark PhD; Kudel, Ian PhD§; Render, Marta L. MD

doi: 10.1097/PTS.0b013e3181839b48
Original Articles
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Objectives: To describe models of nursing communication about medical error.

Methods: Intensive care unit nurses at 4 hospitals that had implemented evidence-based practices to reduce hospital-acquired infections participated in focus groups. They discussed medical error decision making regarding formal reporting, telling someone else about a mistake, or keeping silence. From transcripts, we identified categories and grouped thematic elements; we then triangulated focus group findings with results from a safety culture survey completed by a random sample of nurses from those same intensive care units. Using all sources of data, models of communication were developed.

Results: Thirty-three nurses attended 8 focus groups, and 92 nurses completed the surveys. Focus group nurses remained conflicted about reporting error, using time pressure, and the presence or absence of actual patient harm to prioritize formal reporting. Nurse-reported feedback was rare following formal reports of error. In contrast, responses from the safety culture survey revealed socially desirable answers, with a majority of nurses reporting that they usually or always reported errors and received feedback. Nurses are strongly conflicted about disclosing their errors to peers and physicians. Nurses preferred reporting witnessed errors to their supervisor rather than confronting the peer and used complex maneuvering when communicating with physicians about physician error.

Conclusions: Medical error distresses nurses who are conflicted about disclosing, discussing, and reporting it. Lack of feedback from administration regarding reported errors reinforces the sense that reporting is not useful. Recognizing the barriers to learning about safety from reporting and the need for visibility in communicating lessons from errors is essential as hospitals strive for safe patient care.

From the *Department of Family Medicine, University of Cincinnati; †Inpatient Evaluation Center, Veterans Affairs Medical Center; ‡Department of Psychology, Xavier University; and §Institute for the Study of Health and ∥Department of Medicine, Pulmonary Critical Care Division, University of Cincinnati, Cincinnati, Ohio.

Sources of support: Agency for Healthcare Research and Quality (AHRQ) Challenge Grant 1UC1HD014237-01, Veterans Affairs Research Enhancement Awards Program 03-020, and AHRQ Career Development award K08 HS13914-02.

The funding sources had no involvement in study design or in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Correspondence: Nancy C. Elder, MD, MSPH, Department of Family Medicine, University of Cincinnati, PO Box 670582, Cincinnati, OH 45267 (e-mail: eldernc@fammed.uc.edu).

© 2008 Lippincott Williams & Wilkins, Inc.