There are many reasons to file and not to file. I have filed more in the last two weeks than my entire nursing career. Right now we have some really bad
(and I mean really bad) docs (from an agency)coming through our ED. And risk management has told us the only way to get them out is to file incident reports. I have always been against filing them unless the patient has fallen or hurt themself in some way. Or if a really bad medication error has occurred. Let me give you some for instances - would you have file reports on these things.
#1 - Drunk patient comes in around midnight after falling off a ladder (approximately 8 feet) and landed on his ribs on a cement wall. Complaining, of course, of rib and side pain. MD goes in to talk to patient - never touches patient. Comes out says "do a xray, but he's okay - just drunk" VS are stable at triage. Pt goes to xray. The RN taking care of the patient just feels something isn't right. In xray - pt has a syncopal episode. BP 94/62 HR 124.
1 1/2 hours later - MD returns to re-eval patient. MD aware of BP and syncopal episode. Discharges pt with diagnose of rib contusion. Nurse asked MD to at least check a H&H. MD says "he's drunk. Let him go home and sleep it off" Nurse does orthostatic VS on discharge. Pt's BP when supine is 96/54 and when standing 74/42. Pt is pale diaphoretic and nauseated. Heart rate is 146. MD still wants to send pt home. Nurse is very, very reluctant to discharge pt. "Luckily," pt becomes unresponsive when transferring to wheelchair. Abd is now rigid - injury is now 3 1/3 hours old. RN initiated IVF wide opened to try to increase blood pressure. MD finally orders H&H - RN asked MD about maybe doing a CT scan of his abd. MD says "no need." RN points out that pt's abd in rigid - and since the MD never touched the patient he didn't know this. So finally orders CT scan. And guess what????? Ruptured spleen - surgery called and pt prepped for OR.
So would you have filed an incident report on this MD?? Failure to diagnose and delay in treatment. Luckily no bad outcome - thanks to a great ER nurse.
Tell me what you would have done on this. I'll give you another example next time.