Patient Safety and Quality

Nurses feel left out of the medical error disclosure process

The disclosure of harmful medical errors is actively promoted by patients and health care professionals. However, only 30 percent of these errors actually get disclosed to patients harmed by them. Such disclosures are typically conducted by physicians. In fact, nurses are often left out of disclosure discussions and feel excluded from the process, reveals a new study. Health care organizations that integrate the entire health care team into the disclosure process will likely improve the quality of error disclosure, suggest the study authors. They conducted 11 focus groups with 96 registered nurses at 4 health care organizations near Seattle, Washington. Participants were asked to share information about a serious safety event that occurred and what was communicated to the team and the patient.

They were also asked to comment on their institution's culture and policies on disclosing medical errors. The study found that nurses routinely disclosed errors that caused either no harm or minor harm. However, when it came to more serious or team errors, the participating nurses were not fully encouraged to participate in the disclosure process. In addition to not knowing if an error had actually been disclosed, the nurses were often not told what was explained to the patient. These inadequacies in communication led nurses to share information with patients and families that was ultimately inaccurate, incomplete, or ill-timed. Nurses also admitted to either avoiding questions about errors altogether or providing indirect answers. Some even resorted to deception at times as a way to avoid discussion.

Unlike physicians, nurses saw the disclosure process as a team event rather than a physician-patient conversation. They cited hierarchical relationships between physicians and other health care professionals as having a negative impact on such open dialogue. The authors recommend that hospital administrators support the role of the nurse manager as a resource for error disclosures through training and education. The study was supported in part by the Agency for Healthcare Research and Quality (HS65801 and HS01201). See "Disclosing errors to patients: Perspectives of registered nurses," by Sarah E. Shannon, Ph.D., R.N., Mary Beth Foglia, Ph.D., M.N., M.A., R.N., Mary Hardy, M.A., R.N., and Thomas H. Gallagher, M.D., in the January 2009 Joint Commission Journal on Quality and Patient Safety 35(1), pp. 5-12.

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