Documenting Medical Errors in Pediatric Patients

Introduction

Medical error reporting is an important component of enhancing patient safety in hospitals. Efficient and reliable systems track, identify and report medical errors that compromise the safety of patients. Many medical practitioners fail to report medical errors or conceal certain errors because of the legal implications of reporting. Studies have shown that reporting systems in many hospitals are underutilized and fail to provide accurate information that can enhance patient safety (Kalra, Kalra, & Baniak, 2013). Physicians and nurses need to determine the frequency, types, and effects of medical errors to improve patient safety. It is also necessary to compare the errors identified by nurses and physicians versus those identified by other health care providers. The disparity can be used to identify the cause of the differences and how the problem can be addressed to improve the quality of care and the safety of patients.

Background of study

Medical errors are prevalent among physicians and nurses. These errors compromise patient safety because they result in unfavorable outcomes that have health and financial consequences (Taylor et al., 2004). Medical errors are common in all hospital settings. However, they depend on the knowledge, attentiveness, and professionalism of practitioners. Errors in pediatric patients are usually underreported because of the ethical and legal consequences associated with them (Kalra et al., 2013). This issue is being studied because medical errors are common in hospital settings and are one of the many challenges that the health care system needs to address thoroughly. Many nurses and physicians do not use incident reports as required and fail to report certain errors. The study is significant to nursing because reporting medical errors is an effective way of upholding nursing ethics and acting morally. The nursing practice is guided by a code of ethics that upholds professionalism. The objective of the study was to describe the quantity and types of medical errors reported by nurses and physicians through incident report systems in pediatric patients (Taylor et al., 2004). The study also aimed to evaluate the attitudes of nursing regarding certain interventions to mitigate the problem of increasing medical errors. The recommended interventions can be used to improve nursing practice and enhance patient safety.

Method of study

The researchers used a quantitative study method to conduct the study. The research design involved the use of a 5-section survey document, the use of a Likert scale to record the responses, and the use of Mann-Whitney tests to compare the likelihood of nurses and physicians reporting a certain medical error. The sample size included 147 participants (74 physicians and 66 registered nurses) (Taylor et al., 2004). Initially, the researchers selected 200 participants randomly but 53 of them declined to participate. The researchers mailed the survey to participants who were required to complete and mail them back. In the case of participants who did not respond, another copy of the survey was mailed to them after one week. In case a response was not received within four weeks, a research study coordinator contacted the participants to establish whether they were interested in participating in the study or not. Participation was voluntary and participants could decline to participate by informing a research study coordinator.

Results of study

The researchers found out that nurses and physicians were underutilizing incident reports in their practice. 34.8 % of participants had reported less than 20% of the perceived medical errors and 32.6% had reported less than 40% of medical errors committed by their colleagues (Taylor et al., 2004). The findings showed that nurses were more likely to report medical errors than physicians. The main reasons for underreporting medical errors included ambiguity regarding the definition of a medical error, insufficient time to complete the report, uncertainty about who is responsible for reporting errors, and fears of implicating colleagues (Taylor et al., 2004). Interventions that could increase reporting included education regarding errors that need to be reported, feedback from the administration about the outcomes of reported errors, and the introduction of an electronic reporting system (Taylor et al., 2004). Many nurses and physicians are worried about the consequences of reporting certain errors. The results of the study have nursing implications. They challenge the concept of ethical nursing because nurses are guided by a code of ethics that requires them to act ethically and morally in all situations. Failure to report a medical error is unethical and contravenes nursing ethics (Kalra et al., 2013). The findings also reveal one of how nurses compromise patient safety. Failure to report medical errors eradicates the likelihood of making changes that could improve patient safety (Taylor et al., 2004). The results of the study have a great impact on nursing practice, education, and administration. Nurses can use the information to improve patient safety by reporting all cases of medical errors committed. Nursing schools can use the findings to improve their training programs by developing more comprehensive definitions of medical errors. They need to train nurses on effective ways of handling medical errors and the consequences of omitting them in incident reports. Administration teams can use the recommendations on potential intervention strategies to create more effective incident reporting systems and provide a clear definition of a medical error (Taylor et al., 2004). In addition, they can provide a clear explanation regarding the types of errors that should be included in incident reports.

Ethical considerations

The study was approved by the Children’s Hospital and Regional Medical Center’s Institutional Review Board (Taylor et al., 2004). The privacy of the participants was respected because participation was voluntary and no one was coerced into participating. Personal information was sued with the consent of participants and only when they failed to respond within one month. The privacy of patients was protected because the researchers dealt with nurses and physicians only.

Conclusion

Medical errors occur in all hospital settings and are usually underreported due to various reasons that include lack of knowledge, fear of implicating colleagues, and lack of a proper definition of what constitutes a medical error. Many nurses and physicians underreport medical errors during practice and as such compromise patient safety. Reporting errors is an important aspect of improving patient safety in hospitals. Therefore, medical practitioners need to uphold the ethics of their profession and report all errors committed. Patient safety is a critical component of providing quality health care and it is the responsibility of nurses and physicians to improve it. Reporting all errors is important in the improvement of patient safety and enhancement of care provided in hospitals.

Impact of the nurse shortage on hospital patient care: comparative perspectives

Introduction

Nurse shortage is one of the major challenges that face the health care system today. The nursing shortage has severe consequences that affect the well-being of nurses and their ability to provide quality care. In addition, it affects hospital capacity, health care processes, the efficiency of health care systems, nursing practice, and the overall efficacy of the health care system (Aiken et al., 2002). Patient safety and early detection of health complications are two of the most critical areas that are affected by nurse shortage. Nurses, chief executive officers, and chief nursing officers hold different views and perspectives that serve as obstacles to the proper resolution of the nurse shortage problem. The article under review describes a study conducted to evaluate the effects of nurse shortage on hospital patient care. The researchers explore areas such as hospital capacity, patient safety, and provision of timely, effective, efficient, and patient-centered care.

Background of study

Nurse shortage is a very serious problem that the American health care system is currently dealing with and trying to find a lasting solution. The delivery of quality care requires the concerted efforts of many health care professionals because it is complex and challenging. Different health workers (registered nurses, advanced practice nurses, and physicians) play varied roles in care delivery. Therefore, a shortage of professionals in any of the aforementioned groups is detrimental to the quality of patient care. The issue of nurse shortage is significant to nursing because it has a direct effect on the quality of care delivered and the wellbeing of nurses as well as patients (Aiken et al., 2002). An insufficient supply of nurses has severe consequences that include stress, burnout, job dissatisfaction, high employee turnover, work overload, and poor performance (Buerhaus et al., 2007). On the other hand, there is a relationship between nurse shortage and poor patient outcomes such as mortality, high operation, and labor costs, long hospitalization periods, and ineffective patient care. The purpose of the study was to establish the effect of nurse shortage on hospital care. The objective was to determine whether nurse shortage has any effect on team communication, patient care delivery, hospital capacity, the ability of registered nurses to work, and provision of timely, efficient, patient-centered, equitable, and safe care (Buerhaus et al., 2007).

Method of study

The research study adopted a quantitative study method. Surveys were sent to registered nurses, CEOs, CNOs, and physicians in different hospitals. The research design included a collection of data from participants through 4-page survey instruments and analysis of data using SPSS version 11.5 (Buerhaus et al., 2007). Each survey contained information that was specifically tailored to each of the groups studied. However, some of the questions in the survey documents were similar. The sample included 657 registered nurses, 445 medical doctors, 222 chief nursing officers, and 142 chief executive officers (Buerhaus et al., 2007). Therefore, the study had 1466 participants. The surveys were sent to the participants through email. They were given options to either respond by email or visit a secure website that had been developed for the study. The researchers sent five emails to non-responders to encourage them to participate in the study (Buerhaus et al., 2007). Other incentives such as paid-for training programs and entry into draws were also used to encourage participants to respond.

Results of the study

The study found out that there was a prevalent and severe shortage of nurses that had a negative impact on care delivery and hospital capacity. 81% of physicians, 74% of chief nursing officers, 82% of registered nurses, and 68% of chief executive officers reported that there was a severe shortage of nurses (Buerhaus et al., 2007). Only 19% of physicians and 13% of nurses reported sufficient supply (Buerhaus et al., 2007). The results also showed that nurse shortage had an adverse impact on the provision of patient-centered, effective, safe, timely, equitable, and efficient care (Buerhaus et al., 2007). The shortage also affected care delivery and hospital capacity negatively. The findings have certain implications for nursing. First, they demonstrate the need to develop team communication and collaboration for enhanced patient safety and improved quality of patient care. Second, they show how the various perceptions of workers in the health care sector affect care delivery. These perceptions influence the participation of nurses in decision-making and organization as well as the delivery of patient care (Buerhaus et al., 2007). The findings have a great impact on nursing practice, education, and administration. The results provide vital information that can help nurses to improve their practice through collaboration. On the other hand, it provides administration teams with information on the importance of involving nurses in decision making, and the organization and delivery of nursing care. The information can be used to mitigate the problem through increased collaboration, interdisciplinary teamwork, and education on safety improvement in hospitals. The effects of nursing shortage on patient care and nurse wellbeing is a critical part of nursing education (Aiken et al., 2002). The findings can be incorporated into the curriculum used for training in nursing schools. Nurses play a key role in ensuring the safety of patients in hospitals (Buerhaus et al., 2007). The results of the study can play an important role in educating nurses and other professionals to change their perspectives regarding the definition of patient safety threats. Schools of nursing could use the findings to develop courses that focus on improving patient safety by inculcating specific professional competencies.

Ethical considerations

Each of the surveys was approved by the Institutional Review Board. The privacy of the participants was protected because participation was voluntary and any personal information was collected or used with their consent. The discretion of the participants was respected and nobody was coerced to take part. Participation was voluntary and a personal decision.

Conclusion

Nurse shortage is one of the challenges that the health care system faces in the delivery of care. Job dissatisfaction, work overload, burnout, stress, reduced performance, employee turnover, and high emotional exhaustion are some of the adverse effects of nurse shortage in hospitals. Health care professionals have varied perspectives regarding the effect of nurse shortage on care delivery. For instance, CEOs do not fully comprehend the role that nurses play in detecting patient complications or improving patient safety. Therefore, they leave them out of the decision-making processes and organization of nursing care. The findings of the study are significant to nursing because they provide information that can be used to improve nursing practice, education, and administration. Studies have shown that nurses’ timely reaction to patient complications lowers mortality rate and increase patient overall wellbeing. The research design used ensured that the study was carried out properly and biases were minimized. The results of the study have several implications for nursing. They can be used to influence nursing practice, education, and research. Implementation of the findings can help administrators and nurses to mitigate the problem of shortage by enhancing collaboration and incorporating them in nurse training programs.

References

Aiken L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. Journal of the American Medical Association, 288(16), 1987-1993.

Buerhaus, P. I., Donelan, K., Ulrich, B. T., Norman, L., DesRoches, C., & Dittus, R. (2007). Impact of the Nurse Shortage on Hospital Patient Care: Comparative Perspectives. Health Affairs, 26(3), 853-862.

Kalra, J., Kalra, N., & Baniak, N. (2013). Medical Error, Disclosure, and patient Safety: A Global View of Quality Care. Clinical Biochemistry, 46(13), 1161-1169.

Taylor, J. A., Brownstein, D., Christakis, D., Blackburn, S., Strandjord, T. P., Klein, E. J., & Shafii, J. (2004). Use of Incident Reports by Physicians and Nurses to Document Medical Errors in Pediatric Patients. PEDIATRICS, 114(3), 729-735.