Patient Safety and Quality

ICU nurses handle medical errors differently than they say they do on survey

How nurses deal with medical errors on the intensive care unit (ICU) may differ broadly from what they report on surveys of patient safety culture, according to a new study. ICU nurses at a group of hospitals who completed the Agency for Healthcare Research and Quality (AHRQ) Hospital Patient Safety Culture Survey replied that they usually or always reported errors and received feedback from their administrators. However, ICU nurses from the hospitals who participated in focus groups on error communication and reporting said that they often did not report errors that caused no harm to patients—in contrast to the 55 percent of these nurses responding to the AHRQ survey who said that they reported such mistakes. The nurses in the focus groups also said that they rarely received feedback from administrators regarding the errors that they did report—again, in contrast to the 56 percent of the nurse survey responses that said they did receive feedback.

Even though all of the hospitals had participated in training to reduce hospital-associated infections by improving teamwork, workplace power relationships remained the key to how medical errors were reported, according to the researchers. Although most medical errors are understood to be caused primarily by system problems rather than individual mistakes, the nurses were reluctant to report errors that they were involved with because of a sense of failure or fear of punishment or blame. Nurses who witnessed an error were more likely to report it to a supervisor than confront another nurse directly and nurses brought up physician errors to the doctor only indirectly, often in the form of a question about what the physician meant to order or do, the researchers found.

The researchers conclude that hospitals must understand the realities of error reporting and talking about errors to make headway in improving the safety and quality of the patient experience.

The study was supported in part by Agency for Healthcare Research and Quality (HS13914). Additional information can be found in "Nurses' perceptions of error communication and reporting in the intensive care unit," by Nancy C. Elder, M.D., M.S.P.H., Suzanne M. Brung, M.S.N., M.B.A., Mark Nagy, Ph.D., and others, in the September 2008 Journal of Patient Safety, 4(3), pp.162-168.

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