Patient Safety and Quality

Registered nurses are key to detecting, correcting, and preventing medical errors during critical care

Since registered nurses (RNs) play a pivotal role in preventing or reducing the impact of medical errors during critical care, interventions should build on factors that enhance their effectiveness in preventing, intercepting, or correcting these errors, suggests a new study.

Using entries in daily logbooks maintained by a random sample of 502 critical care nurses over a 28-day period, Ann E. Rogers, Ph.D., R.N., of the University of Pennsylvania School of Nursing, and colleagues examined the type and frequency of medical errors detected by critical care nurses. They found 367 errors identified by 184 of the nurse participants during the data-gathering period. Errors in medication administration (most commonly, wrong drug, wrong dosage, or dose not given) were the most frequent problems. They accounted for 163 of the errors—43 percent of which involve giving the wrong dosage of a prescribed medication. Procedural errors were the next most common (115 errors reported), followed by charting errors (55 instances), and transcription errors (55 instances).

The nurses caught only 43 of the 367 errors—mostly medication errors or overlooked allergies—before they reached the patient. Yet, nurses were particularly effective at discovering and correcting errors that had been made by other nurses and other members of the health care team. The incredibly busy pace of critical care units may play a role in errors, with an average of 187 activities performed for each patient each day. Heavy workloads and fatigue are also factors that may affect the ability of RNs to intercept or correct errors, note the researchers. Their results did not show differences in error types or rates based on the size of the critical care unit or of the hospital.

Because procedures for administering medications and other health care procedures are similar across health care institutions despite how they are organized or their size, the researchers suggest that future studies should focus on system- and process-related factors. Their study was funded in part by a grant from the Agency for Healthcare Research and Quality (HS11963).

More details are in "Role of registered nurses in error prevention, discovery and correction," by Dr. Rogers, Grace E. Dean, Ph.D., R.N., Wei-Ting Hwang, Ph.D., and Linda D. Scott, Ph.D., R.N., in the April 2008 Quality and Safety in Health Care 17(2), pp.117-121.

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