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Patient Safety/Quality

Anonymity, feedback, and a blame-free environment promote reporting of medical errors

Nurses and doctors know they should report medical errors associated with serious adverse events, but they often are uncertain about the need to report less serious errors or near misses, according to a recent study that was supported by the Agency for Healthcare Research and Quality (HS11898). Researchers led by Donna B. Jeffe, Ph.D., of the Washington University School of Medicine, analyzed audiotaped discussions of nine focus groups—four involving 49 staff nurses, two with 10 nurse managers, and three with 30 physicians—from 20 academic and community hospitals in 2002.

Focus group discussions revealed that nurses were more knowledgeable than physicians about how to report errors. All focus groups mentioned barriers to error reporting: not knowing what to report, not knowing how to report, fear of repercussions (culture of blame), lack of confidentiality, lack of time and easy systems for reporting, and lack of followup on errors reported.

Nurses and doctors said more errors would be reported if there were clear guidelines for what to report, clear reporting mechanisms that health care providers have been trained to use, a blame-free mentoring/collegial environment, anonymous reporting mechanisms, sufficient personnel and efficient reporting tools, and routine followup of error report. Such followup would help to educate staff and demonstrate that hospitals intend to act on error reports.

Physicians' reluctance to report errors is based on fear of litigation and fear of criticism and embarrassment in front of their peers. Fear of reprisals has also been noted by nurses. Nurses and physicians both alluded to the necessity of a culture change that would result in anonymous reporting, freedom from punishment, and consistent educational feedback about errors that are reported.

For more details, see "Using focus groups to understand physicians' and nurses' perspectives on error reporting in hospitals," by Dr. Jeffe, William C. Dunagan, M.D., Jane Garbutt, M.B., Ch.B., and others, in the September 2004 Joint Commission Journal on Quality and Safety 30(9), pp. 471-479.

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