Strategies Used by Critical Care Nurses to Identify, Interrupt, and Correct Medical Errors

Elizabeth A. Henneman, RN, PhD, CCNS; Anna Gawlinski, RN, DNSc; Fidela S. Blank, RN, MBA; Philip L. Henneman, MD; Deovina Jordan, PhD, MD, MSN, MPH, RN-BC; Janice B. McKenzie, RN

Disclosures

Am J Crit Care. 2010;19(6):500-509. 

In This Article

Abstract and Introduction

Abstract

Background Medical errors are common in intensive care units. Nurses are uniquely positioned to identify, interrupt, and correct medical errors and to minimize preventable adverse outcomes. Nurses are increasingly recognized as playing a role in reducing medical errors, but only recently have their error-recovery strategies been described.
Objectives To describe error-recovery strategies used by critical care nurses.
Methods Data were collected by audio taping focus groups with 20 nurses from 5 critical care units at 2 urban university medical centers and 2 community hospitals on the East and West coasts of the United States. Transcript content was analyzed as recommended by Krueger and Casey.
Results Analysis of focus group data revealed that nurses in critical care settings use 17 strategies to identify, interrupt, and correct errors. Nurses used 8 strategies to identify errors: knowing the patient, knowing the "players," knowing the plan of care, surveillance, knowing policy/procedure, double-checking, using systematic processes, and questioning. Nurses used 3 strategies to interrupt errors: offering assistance, clarifying, and verbally interrupting. Nurses used 6 strategies to correct errors: persevering, being physically present, reviewing or confirming the plan of care, offering options, referencing standards or experts, and involving another nurse or physician.
Conclusions These results reflect the pivotal role that critical care nurses play in the recovery of medical errors and ensuring patient safety. Several error-recovery strategies identified in this study were also reported by emergency nurses, providing further empirical support for nurses' role in the recovery of medical errors as proposed in the Eindhoven model.

Introduction

Medical errors and adverse events are common in intensive care units,[1–5] and nurses are often involved in medical error recovery (ie, identifying, interrupting, and correcting medical errors) and preventing adverse outcomes.[6] Although nurses have been recognized for their role in reducing the number of medical errors,[2,4,5,7,8] only recently have nursing strategies for error recovery been described in the literature.[6,9] Analysis of medical errors and adverse patient outcomes by the Institute of Medicine[10,11] and others[7,12] has shown that these errors result from both human and system failures. These analyses have led the health care community to issue a call to action to begin systematically addressing medical errors. This action plan requires investigating both the root causes of errors and methods for reducing the number of adverse events.

Most adverse events are believed to result from system failures, many of which have been identified and preliminarily addressed.[11] Although the importance of addressing system problems has been emphasized, clinicians at the point of care remain generally accepted as the final safeguard against a dangerous situation adversely affecting patients. In critical care settings, nurses caring for patients at the bedside are well positioned to transform potentially adverse outcomes into "near-miss" situations, thus improving patient safety.

Nurses play a role in ensuring patient safety by recognizing and reducing complications.[13,14] Although nurses' role in preventing medication errors was identified more than a decade ago,[7] only recently has nurses' pivotal role in addressing many other types of medical errors been identified.[2,3,5,6,8,9]

Experts have suggested that patient safety depends as much on preventing devastating incidents by improving systems as it depends on maximizing the ability of individuals at the point of care to stop dangerous situations by identifying, interrupting, and correcting errors.[7,9,10,15,16] Nonetheless, little attention has been paid to the integral role of bedside nurses as the final defense against system failures and dangerous situations.[6,9] To address this gap in knowledge, we conducted this exploratory study to describe strategies used by critical care nurses to identify, interrupt, and correct medical errors.

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